as much as I mourned leaving Paris and joining a system I loathed, that fateful decision made on a bench in the Parc Monceau will lead me towards a career that comes with much pleasure and professional satisfaction.
But first there is a price to pay.
2
An introduction to psychiatry
I am the property of the State: 68504194BG. That is me, a number. It comes before my name.
I step off the plane in Johannesburg, kiss my mom and dad and sister, shave off all my hair, and, with thousands of other recruits, climb onto a train heading west to Klipdrif. For three months we run, jump, crawl and climb to the accompaniment of men screaming into our ears about how fucking useless we are. Lower than snake shit – that is what one corporal calls us. I will hear it many times during my period in uniform.
Oh, those days in officers’ school. One day we are coming off the parade ground after three hours of endless marching, the warm winter sun low on the horizon, the rays mingling with clouds of dust thrown up by a thousand marching feet, the air a burnished gold.
No doubt we are poor foot soldiers, slow to respond to the shrill screams and exhortations of the drill instructors: left turn, right turn, halt, forward march, left wheel, right wheel, attention, stand easy, up and down, down and up, on and on and on to the point of dehydrated insensibility that is disconnected, almost other worldly.
It is in this state of torpor that our platoon limps past her – a female corporal and member of the standing army. She is attractive, albeit in a butch way, but it is the sneer on her face that holds our attention, top lip curled insolently as she spits out her contempt for what she has just witnessed: ‘Julle dril so swak, dit maak my poeshare krul’ (Your marching is so poor it makes my cunt hairs curl).
No one responds. Not one of us well-educated doctors can fashion a reply. So complete is her damnation it stymies a quick comeback. All we can do when the full weight of her words have sunk in is laugh and shake our heads in disbelief. Until then, I never knew there were women who could talk like this.
This kind of madcap thinking is everywhere, it is like a virus. After our basic training we are each given a piece of paper and told to write down our name and pick a specialty. The army will do its best to accommodate you, we are told to barely concealed snickers. So, I put down plastic surgery.
I have some vague notions of wanting to be a plastic surgeon because the aesthetics appeal to me. You take a tuber and turn it into the cutest little nose, and then stand back and watch the person enjoy a new life. And it sure pays the mortgage. That last bit of advice was given conspiratorially by one of my lecturers at medical school.
So I choose plastic surgery as my contribution to the nation, but what does the nation give me? Psychiatry. There must be a mistake, I think, but it turns out there is not. Plastic surgery has a couple of slots only and they are filled in no time. So, what comes next?
‘Psychiatry of course, stupid.’ This is explained to me by a very pock-marked, extremely irritable sergeant. ‘Shit,’ he yells, ‘don’t you know your alphabet? PS comes after PL. Now fuck off.’
The army decides that I am to be a psychiatrist. There’s nothing I can do about it – I am lower than snake shit. I have my orders and off I go.
The army’s main medical centre is in Pretoria. A brand-new hospital has been built up on a hill, where it sits like a gleaming trophy. One Military Hospital is the official name, but everyone calls it 1 MIL. Nothing has been spared, no expense too great, state-of-the-art equipment and facilities. The old 1 MIL is at the bottom of the hill, a hodgepodge of decrepit, ramshackle wards and offices – and it is here that the mentally unwell are admitted.
Day one and I say good morning to my new boss, a pint-sized colonel with an exotic name, at least by SADF standards – Ronaldo de Jager. His smallness is disconcerting at first, all those sartorial trappings of power, the glinting epaulettes and stiff-peaked cap with orange band, the works sitting awkwardly on so petite a frame. The nurses tell me he is very experienced and has been dealing in mental illness for years. That may be, but first impressions are jarring. All his movements are jerky, twitchy, like a marionette, and he is asthmatic too. Within minutes of meeting him, I hear a wheeze. Out comes his puffer and up to his mouth it goes, but oh my goodness the coordination is dreadful. The first squirt misses completely. Spray shoots by his cheek and past his ear. Perhaps that was a practice run? No, not at all. He caps the inhaler and pockets it. The wheezing stops.
Playing my violin at Klipdrif.
The psychiatry unit is a large one and to manage the clinical load another conscript, a colleague of mine from medical school, is seconded with me. David is a delight, a real charmer and a connoisseur of women. Listening to him describe the unique characteristics of some beauty who has caught his eye is like taking a university course in art appreciation. Even women whose looks tend towards the ordinary arouse him to extraordinary levels of fantasy, anchored in a stellar record of seduction and an almost clairvoyant understanding of what women find erotic.
Less appealing is the personality of a third conscript, who has been in the unit for six months already. Both David and I remember him well from medical school. But this short, dumpy man with a formerly laid-back, benign temperament has morphed unrecognisably into a bossy, officious fellow. He scurries here and there ordering us about, admonishing us, and yes, even occasionally complimenting us, puffed up as he is with a bogus seniority. At first we are amused by his antics, but there is spite in his bombast and within weeks we tire of him, give him the nickname ‘Warthog’ and avoid him as much as we can.
To my surprise I find the work fascinating. I know very little, but I am eager to learn. The last psychiatric patient I saw was three years back, during a six-week block of psychiatry as a medical student. That has been the sum total of my training. Now, in a blink, I am given a lot of authority for very sick patients.
Severe mental illnesses – the schizophrenias and the bipolar disorders – present for the first time in the late teens and early twenties. Just about the time the envelope with that dreaded postmark arrives. Coincidence, I am sure, but the demographics keep us very busy. My days are awash in psychosis: boys talking to the stars, or howling like wolves, or convinced they are being poisoned, or claiming to be Jesus. Lads with plans to make billions, cure cancer or turn corn chips into gold, young men so depressed they beg for death and go looking for it with a rope or a bottle of pills or, worst of all, a gun. No shortage of those, of course. State-subsidised suicide.
Two months into the asylum work and I don’t hanker after plastic surgery any more. A wounded mind is now of more interest than some nip and tuck, or mammeries that nature has short-changed. And it is not just the delusions and hallucinations that hold my attention. It’s the pathos of lives that have come off the rails. There is a world of sadness wrapped up in these walls. The psychotic patients, floundering in another dimension, are unaware of their plight. Their families see it all, though. When Mom and Dad arrive at the gates to pick up their lost son, their worry lines run deep, shoulders slump and anxiety makes their eyes dart like pinballs. The army knows there is no way back for these boys. Damaged goods must be returned.
At times I flounder, for some patients’ problems are complicated and I am a novice. Do I know what I am doing? I am given a man’s mind to work with and I worry that I am in breach of Hippocrates’ sacrosanct principle taught to us in medical school: Primum non nocere — First, do no harm. Implicit is the cautionary advice that we as doctors should desist from risky decisions of which the consequences are hard to predict. To offset
