Mr Ntuli and I haven’t spoken before. I’ve assumed that we don’t speak the same language, which is really just an excuse for me not to talk to him. He’s been in the hospital for nearly two months. I know because I’ve been counting. He came in with a gunshot wound to his abdomen. He was in the ICU for two weeks, where the senior dietician was seeing to his intravenous feeding. The bullet pierced the lower section of his colon and the surgeon had performed a colostomy. The senior dietician told me that his sister had brought him into the hospital. He’d gone missing one night, and his family found him the next morning, collapsed on the pavement near his son’s school. Apparently there was someone visiting him every day in the ICU, although I haven’t seen any visitors since he’s been transferred to my ward.
His eyes are closed this morning, which means that I don’t have to talk to him. I put my file down soft as tissue on the table at the foot of his bed, so as not to wake him, and flip to today’s date. It’s a Tuesday. The blood test that he had yesterday morning showed that his albumin level had dropped over the weekend. It might be from those standard intravenous bags that the nurses give the patients on Saturday and Sunday. Also, if the staff rotate sometimes the weekend nurses don’t read or follow the rate that I’ve written on the chart, correctly. Also, I must make sure that Mr Ntuli gets the right intravenous feeding bag on both days this weekend. I’ll have to bring up a batch on Friday. I must also make sure that I know what’s happening with the nurses and I must speak to someone who will be on duty.
I check the doctor’s notes in the hospital file to see if they’ve redone Mr Ntuli’s bloods this morning, but they haven’t. The doctor has scribbled a note that I cannot read. It’s only a short insert though, so I assume that they haven’t got any big plans for Mr Ntuli and that he’s stable. Yes, I must ask the ward doctor when they are going to redo the bloods so that I can see if the increased feeding rate that I started with yesterday morning is having any effect. Although it does take the blood albumin a few days to adjust and show.
I check Mr Ntuli: he’s still sleeping. He looks peaceful, which disturbs me; he doesn’t normally. I feel like I should cover him up, but he’s on top of the bedding. His stoma bag nauseates me only a little bit more than does his urine bag, which hasn’t been emptied and is full to bursting.
He was doing better a few weeks ago, and I decided to try him on oral sips to see if he would tolerate it. That went well – he enjoyed drinking – and so we moved him onto a liquid diet, all the time keeping the intravenous feed going. The liquid diet also went well: there wasn’t an excess of effluent in his stoma bag. But then Mr Ntuli developed an infection and had to be moved back to the ICU.
When I told the junior dietician the story in the office, she said: ‘Are you crazy!? You should have never moved him onto a liquid diet, before having established him properly on tube feeding. He was much too vulnerable. That’s one of the first things we learnt about transitioning patients between feeding methods.’ She said everything short of saying, It’s all your fault, although she more than implied this. I shouldn’t have said anything to her.
It was then that I thought to ask the senior dietician what she thought of the situation. I imagine the exchange between us would go as follows:
‘Should I have not moved Mr Ntuli onto a liquid diet, while he was still on intravenous feeds?’ I’d ask her quietly, sincerely and with deference, guilt, and embarrassment.
And she would respond calmly, in the way that she always does, ‘No, it’s fine. I know that was one of the first things we learnt about transitioning patients, between feeding methods, but it’s different, in the real world.’
This is my fantasy, but I decide not to test it. Maybe I don’t ask the senior dietician about the liquid diet for the same reason that I don’t really speak to Mr Ntuli: I’d be proved the fraudulent and incompetent community-service dietician that the junior dietician likes to think I am, and that I secretly suspect I am. Anyway, Mr Ntuli returned to my ward within a week after the infection and he was fine.
I write today’s date under the doctor’s notes. Mr Ntuli’s eyes are still closed. I always smile at him when I enter the side cubicle. Sometimes he smiles back. He always smiles back after I’ve said, ‘Hi, how are you?’, although I’m not sure he understands what I’ve asked him? I usually don’t ask him anything else, although we did have some communication over the liquid diet intervention. I had the nurse explain to him what was happening and then said, ‘Yes?’, smiling, and he nodded. If the nurse wasn’t there and I wanted to check how it was going with the liquids, I would smile and ask, ‘Yes?’, and he would nod back. In the beginning, I wouldn’t let the nurses feed him fluids if I wasn’t there, but once I saw that he was tolerating it, I let them do it without me. All the nurses agreed that he was doing well on the liquid diet.
But now he’s only on intravenous feeds. In his file I write for them to continue with the rate that I set yesterday and then sign my name. I try to work out the doctor’s surname from his signature above, but the word is illegible. It looks like it starts with a D. He’s new in the ward, this doctor. He started in gastroenterology at the beginning of the month when the student doctors rotated their internships. The nurses don’t like the new ones; they say that they’re bossy.
I must remember to ask about the bloods. I write a note in the file and then sign my name again. Then I write a note in my own file under today’s date. Then I check the input/output chart and Mr Ntuli’s sleeping face, which still looks peaceful. I wonder why his family isn’t visiting him here anymore.
‘Please will you just continue with same rate for Mr Ntuli’s feed today,’ I tell the nurse who’s behind the ward’s front desk. She looks like a student nurse. ‘Mr Ntuli, in the side cubicle. Don’t change anything. Where are the doctors?’
She doesn’t know.
‘Okay, I’ll see them tomorrow. Mr Ntuli’s urine bag needs to be emptied.’
I start the descent to the dietetics office on the lower ground.
On Wednesday morning Mr Ntuli’s covered with a sheet and a blanket. The linen is starched and stamped with ‘Republic of South Africa,’ turned over a camel fleece and tucked in at the edges. The doctors still haven’t done the bloods. Mr Ntuli’s still sleeping in front of a wall the colour of clotted cream. I don’t write in the hospital file.
‘Where are the doctors?’ I ask the sister-in-charge at the front.
She tells me that they are in theatre today.
‘What’s going on with Mr Ntuli? Why’s he sleeping all the time?’
‘He was awake in the night,’ she says, adjusting her navy jersey over her stomach. ‘He was crying.’
‘They said he was asking for a blanket. I wasn’t here.’
I feel terrible. ‘Who was here?’
She points a long finger down the passage, and I follow her lead with my gaze until it rests on the student nurse from yesterday, in whose direction I begin to march.
‘Did you give him the blanket!?’ I explode at her.
But she doesn’t seem afraid. ‘What?’
‘Did you give Mr Ntuli a blanket, in the night, when he was crying?’
She looks puzzled and then amused. ‘What?’
The senior dietician doesn’t know what’s going on either. The ICU doctors also rotated at the beginning of the month and she’s not well acquainted with any of the new ones.
‘But doesn’t the ICU have a permanent doctor?’ I ask her. The head of the unit monitors all the patients there, but she only sees him occasionally.
‘What must I do with Mr Ntuli?’ Please don’t let me fall further.
‘I would continue with the intravenous feed,’ she says. ‘But try to speak to a doctor in the ward, to find out if anything else is happening with him.’
Mr Ntuli’s not in the side cubicle on Thursday morning. I finally locate a doctor – maybe the one whose surname starts with a D. Mr Ntuli has been moved back to the ICU. His blood pressure dropped suddenly yesterday evening.
The first thing that occurs to me is to ask the doctor about Mr Ntuli’s blood albumin.
‘When is he coming back to the ward?’ I beg the doctor.
‘I’m not sure,’ he shakes his head. ‘They’re monitoring him there.’
The senior dietician has no real news. She’s keeping Mr Ntuli on the intravenous feed at the rate that I set. His albumin level hasn’t changed. There’s been no blood in the stoma bag, but the doctors are checking for internal bleeding elsewhere.
‘Did you talk to him?’ I ask her anxiously.
‘Mr Ntuli. Did you talk to him when you saw him? Was he sleeping? Did you talk to him?’
She pauses a moment. ‘I joined the doctors on the morning ward round.’
‘But was he sleeping?’
‘No. I don’t remember. I don’t think so.’
Mr Ntuli remains in the ICU for a week. I become so desperate that I consider asking our Head of Department if I can go with her to the intensive care unit to speak to a doctor there. But then I’ll have to tell her the whole story, including the part about the liquid diet. I wonder if the junior dietician has told her already. The Head of Department hasn’t said anything to me, but then she hardly ever says anything to me. The experiment with the liquid diet was weeks ago and I really don’t believe that I’m responsible for this latest incident.
Mr Ntuli returns to my ward the next week, and I speak to him. He’s in a general cubicle now, where the other men are. He’s in a bed adjacent to the window, which looks out onto a green and grey landscape. I make sure that he has a blanket, that his urine bag has been emptied and that the intravenous feed is running at the right rate.
‘How are you?’ I smile at him.
He smiles and nods back.
He continues to smile and nod.
‘Okay. Where do you come from? Alexandra? Soweto?’ Look how I’m falling into the traps. ‘The Northwest?’
Smiling and nodding.
‘Are you warm enough?’
I get hold of a nurse and tell her to ask Mr Ntuli if he’s warm enough. Does he need another blanket? Where does he live?
She asks him the last question and he tells her, Thembisa.
This is enough for me! ‘Okay, I’ll see you tomorrow,’ I wave profusely at him. ‘Keep the feed at 80 ml per hour,’ I tell the nurse before leaving.
When I’m talking to the junior dietician later in the office she asks after Mr Ntuli in a manner that suggests all my other patients are dying from neglect.
‘He’s fine, thank you,’ I tell her. ‘Much better this morning. He comes from Thembisa.’
I feel the Head of Department’s eyes on me. The junior dietician must have told her about the liquid diet. I want to get up and run before she starts talking.
‘You know,’ the Head of Department says, and I turn to her grudgingly, ‘they always pick up just before they die. It’s some kind of physiological thing. It usually happens.’
She’s a horrible person. She doesn’t care about Mr Ntuli. What does she want me to say – that it’s my fault?!
Mr Ntuli is fine the next morning. He comes from Thembisa. We smile at each other. He’s fine, the following morning too. On the following morning, he dies. I don’t see him. It happens in the early hours before I come to work. The doctor whose surname starts with a D tells me: Mr Ntuli’s blood pressure dropped drastically again.
I don’t tell anyone. I take Mr Ntuli’s file to the stone-grey cabinets at the front of the office. The cabinet on the left-hand side is for patients who have recovered in the hospital and the cabinet on the right is for those who have died. I leaf through the folders under N. It seems absurd to me that there have been other Mr Ntulis that have come and gone through this hospital.
Maybe I could try talking to the senior dietician again. We could sit together with the files for Mr Ntuli, hers and mine, and trace the history. I could ask her why they didn’t keep him in the ICU for longer this last time. I could tell her that Mr Ntuli was getting colder. I could say that the Head of Department had warned me. That the doctor whose surname starts with a D didn’t know what he was doing. That the student nurse in my ward didn’t follow instructions. That no one from Thembisa had visited Mr Ntuli in the hospital for two months. I could explain to her about the liquid diet and show her my records indicating that Mr Ntuli’s blood albumin had increased following the intervention. That he had begun to stabilize at one point. That maybe I should have visited him more often in the ward. Told the doctor what the Head of Department said. Asked after his family.
Carla Chait has a master’s degree in English Literature and was awarded the 2012 Deon Hofmeyr Prize for Creative Writing at Wits. She has had poetry and short fiction published in New Contrast, Carapace, Ons Klyntji, Itch, SmokeLong Quarterly and The Kalahari Review. In 2022, she published her debut novel, Floor 1.