kagablog

28

Nico Swart is a delicately stunted, cerebral palsied ‘child’ of twenty-three. He lies impassive, ignoring my attempt at communication. Then a flick of the black eyes - an inhuman child. At night he brightens up and utters a stream of obscenities like a parrot. Who could have taught him this? It is thought that he has lymphoma, a disease which should dispose of him within the next few months.

29

A turquoise swimming pool set with symmetry in clipped green lawn. Black stripes below the water, white railed steps in the corners. An upturned bench on the grass. Rain falls from a heavy sky and from the shelter of the veranda I watch the drops disturbing the surface of the pool. The air is clean and cold and does not smell of sickness.

30

Goodman: I’m a good psychologist. I can sum people up at a glance. I looked at that man and I could see he was swollen-headed. I took an instant dislike to him. What does he think? He thinks he is important, some kind of Very Important Person. You know, the Bible says all flesh is as grass, and all the glory of man as the flower of grass. The grass withereth and the flower thereof falleth away.

Suddenly I am very bored. How can I take this?

Goodman has lost a five-cent comb.

My comb has been stolen. Whilst I was asleep. Last time I was in here I was drugged and someone stole my teeth.

31

Johnson is seventy-two and has a rare blood disorder called Von Willebrand’s disease.
I am busy with research. I have been doing research into my condition for the past forty years.

‘I feel indisposed to receive any visitors today. I couldn’t be bothered, they’re too much trouble. I’m a very sick man. I’m not one to complain. I am very independent.’ And this after having got me to change his pyjamas for him merely because he likes to feel fresh and enjoys constant attention.
I would have committed suicide long ago if my religion permitted it.
What religion is that?
The Jewish religion. It forbids suicide, otherwise I would have done it long ago.

32

After a hard day, the last hour of which was spent helping with the restraint of a crazed cirrhotic whilst the houseman performed a lumbar puncture, I emerged from the hospital to be confronted, on rounding a corner, by the massive shape of Devil’s Peak. Its dark enormity, blown with cloud and shadow, reared so impossibly high and overpowering that I was flooded with a sense of foreboding.

Was it the violence of the wind raging up there across the Devil’s face that so filled me with fear?

33

DEMENTIA, according to Merck’s gospel, 13th Edition: a syndrome of progressive irreversible cerebral insufficiency caused by organic factors and characterised by predominant cognitive functional loss.

The clinical picture is of slow disintegration of personality and intellect because of impaired insight and judgement and loss of affect. The progression of the disease is more painful to the beholder than to the patient. Interests become restricted, outlook becomes rigid, conceptual thinking becomes more difficult, and some poverty of thought becomes apparent. Familiar tasks may be performed well, but acquiring new skills is difficult. Initiative is diminished, and the patient may become distractible. In addition, a global defect eventually develops, involving all aspects of higher cortical function. Along with the cognitive dysfunction, specific disturbances of speech (dysphasia), motor activity (dyspraxia), and recognition of perceptions (agnosia) may be discernible. Memory impairment increases, beginning with problems recalling recent events or finding names readily: the impairment varies greatly from time to time and often from moment to moment. It can be circumvented at first, but as the defect increases, remote memory is also progressively impaired. Characteristically, orientation becomes impaired at first for time, later for places, and finally for person.

In some patients, cognitive dysfunction is preceded by modifications in their usual behaviour and emotional responses. Typically, affect is blunted, but in early stages it may be excessive. Normal personality traits may become exaggerated or caricatured: an obsessive patient may be unbearably pedantic and rigid (organic orderliness), or a sociable extrovert may be facile and inappropriately jocular. The initial affective change may be dominated by irritability with periods of anger and violence. Depression is common. If the mood change (depression, anxiety, or elation) is sustained, the disorder may be misdiagnosed as a primary affective condition. Affect becomes more and more shallow and evanescent as the condition progresses and finally gives way to severe blunting, marked perhaps by a fatuous euphoria without depth.

The patient may embark on foolish and ill-judged, perhaps illegal, activities, but he cannot sustain them as his motivation and drive decline. Habits deteriorate, and the patient becomes slovenly, dirty, and eventually incontinent, culminating with the need for total nursing care in later stages of the illness.

Senile dementia: There is no treatment.

34

I am irritated by Archie Morgan’s whining. He has a steadily swelling scrotum that is fast approaching the proportions of a soccer ball, he has the grotesque bloated belly of a starved child, skinny, stick-like arms and shoulders, and a suppurating anus.

35

Archie Morgan exudes the foul sweet smell of a septic wound. At twenty-eight he is a bearded, long-haired derelict with ascites, liver failure and perineal abscesses.

His stomach works frequently and it is a difficult, messy procedure. From the moment the curtains are drawn the trouble begins. He feels the pan:
‘Hey, no Man! You want to freeze my arse off?’
This is a delaying tactic which must be ignored. If the pan is warmed he says:
‘Hey, no Man! You want to burn my arse off?’
Two pairs of hands are needed, one to help him lift himself, the other to slide the pan under him. He is weak and in discomfort and does not like to move or even be moved.
‘Now listen, be careful. Please, Man. Don’t grab me there! Oh my fuck! No, don’t. I can’t take this pain. Nurse, what are you DOING? Hold it. Jesus no. Careful. Oh my God!’
He is such a wreck. Alcoholism to liver failure to ascites. Generally deteriorating health and unhygienic personal habits have encouraged the formation of anorectal abscesses: neglected, they have developed into a fistula. So each time his bowels move the wound must be cleaned and dressed. For this he has to be turned on his side - another process punctuated with yelps, oaths and groans.
The odoriferous combination of ‘purulent discharge’ and faeces - his especially - produces a strange effect. Once one has become better acquainted with this smell it loses its nauseating quality and assumes an esoteric fragrance, like opium and lust in an oriental brothel.

36

Archie Morgan employs flattery with such obsequiousness that I laugh openly.
‘You’re just the man I wanted to see. You’re my friend, hey. I tell you, when I knew you was coming on duty, when I saw you come through the door into the ward, you know my heart started beating. You know, kind of fast. No, really. I’m not bullshitting you. You’re my friend. Hey listen. Do us a favour, won’t you? I don’t like to ask but would you do us a favour? Just one little favour. I don’t like to ask you.’
‘What do you want?’
‘You know. The usual. You KNOW.’
‘You want another cigarette? They say you’ve got to cut down, Archie.’
‘No, not that. For fuck’s sake!’ Whispers: ‘Come here, Man.’
I bend close and he says, ‘Won’t you get me a pan?’

37

We killed Palmer this morning. There was obviously no hope and it was convenient that he should die before lunch. A nasogastric tube was ordered. Benny Lipschitz had a lot of trouble passing it. Finally he decided it would not go down and tried to withdraw it. To his amazement it wouldn’t come out. This had never happened to him before. There was nothing for it but to use force so he wrapped the free end round his right fist, put the palm of his left hand steady against Palmer’s forehead, braced a foot against a leg of the bed and yanked, like starting an outboard motor or lawn mower. It whipped out with a spatter of dark blood. Unbelievable! It had knotted itself! The patient was alive enough for his yellow eyes to register dull horror at what was being done to him. If he could have walked he would no doubt have left there and then, never again to place himself in the hands of anyone remotely medical. He vomited a quantity of ‘coffee grounds’ and lay groaning weakly. Anxiously Doc Lipschitz looked at his watch and moved his attack to a lower level. That did the trick. Whilst a tube was being forced up through his penis Palmer vomited with finality and gave up the battle.

38

Certainly I have become callous. I rarely feel compassion for them. I am tired of feeling compassionate. Now I often see them merely as sources of entertainment, hardly bothering to empathise with even the most pitiful of cases. And as a result I learn nothing.

39

Louw, the fat farmer, is most confused and in mortal fear for past misdemeanours. Nemesis. For stealing sheep and screwing Coloured girls he is now paying and praying.
‘God sal antwoord.’