I was into my second year of internship at Johannesburg General Hospital or “Joburg Gen” as we medics refer to the huge, somewhat gloomy, old public and teaching hospital in Johannesburg, South Africa. After a 6 year medical degree, South African medical graduates are required to complete two years of practical training referred to as ‘internship time’ in a public hospital and after that, a compulsory year of community service whereby we were placed, usually in smaller hospitals or clinics in high need and highly impoverished communities.
I was in my surgical rotation and it was a Thursday which meant it was ‘intake day’- this was the day where we would ‘take in’ patients into the ward for further in-hospital, surgical care. As the junior doctor in the unit, it was my job to ensure all the clerking was done- the medical history, clinical examinations and getting all the basic tests run to have ready for ward rounds where my formidable team of seniors could consider and action the correct plan for each patient.
He was the last patient waiting at the end of a very long line of patients and a very very long day. He had been waiting patiently, like most patients in the overloaded South African public healthcare system for hours.
A twelve year old boy, whom I knew to be the gentlest soul before we even locked eyes. He cast a shy and lonely silhouette sitting there – small and wasted for his years – his disease leaving him with a body more like a 7 year old.
As I approached, I distinctly felt my heart squeeze- why was this little thing waiting for the surgical ward and why was he all alone?
“Hi…. I’m Sim” I said gently (conscious that I was in my scrubs and stethoscope- imagining the whole scenario must have felt so intimidating for him) as I kneeled down to make eye contact with him. As he shyly and uncertainly met my gaze and introduced himself, I knew I had just met one of the most special souls on this earth. His soul spoke volumes shining behind those bright eyes and shy smile.
Tsepho had liver cancer. Very advanced liver cancer. The kind that needed some surgery but that would likely not be curative. His parents had passed away some years back and besides for his brother who worked 2 jobs to support them, he was entirely alone in life. Not to mention, he was facing a terminal illness entirely alone.
As I came to know him, beyond his scrawny and starved legs and belly swollen disproportionately from the cancer growing inside him, his courage and gentleness stirred my soul and fundamentally changed my life forever.
He underwent an operation in that ward and was discharged some weeks later- the cancer was not cured and he would need to endure a journey of chemo. During those months, he sometimes received care at the “Joburg Gen” where I had since rotated into other departments to complete my training or he would receive his chemo at Chris Hani Baragwaneth Hospital. We stayed in touch and became friends.
“Hi Sim..” he would text me every time he came to the hospital to receive his care and I was always delighted to spend time with him- we would sometimes sit on the benches outside chatting about life, sometimes we would sit together in complete silence- just enjoying the comfort and support of each other in the unspoken knowledge of the inevitability that his life was to be a short one.
As his cancer grew stronger and his chemo became more brutal, I remember many times of sitting at his bedside in my off duty time- just sitting for hours and hours watching this beautiful angel of a human being in so much agony or sleeping for hours to try to recover some capacity from the hardship of the chemo. All alone, he would diligently he would keep his hospital appointments for treatment. The responsibility of this alone, in addition to the hours of public transport it would have taken him to get to the hospital every time, must strike you as remarkable, nevermind the health journey itself he was enduring. All alone he endured his chemo. 12 years old. He never complained. Each time he opened his eyes – the same gentle twinkle in them – the same quiet, gentle, unspoken bravery despite all the pain and crippling side effects of his treatment. 12 years old.
As he became more sick, naturally, I was heart-broken. “You must have boundaries, Simone, don’t get too attached”, my family members would say – trying with the best of intentions to spare me my pain. But I knew my heartbreak was a tiny price to pay for walking alongside this beautiful boy on his journey toward death.
The day came when the “Hi Sim…” messages stopped.
I was there in the township for his funeral – a culturally unsavvy white girl – deeply embraced by his community, as is the warm and magnificent traditional way of black South African culture.
That was 16 years ago, and I am still crying as I write this story – not one of sadness but profound privilege for knowing this human and walking together for the brief but life-altering time we did.
Health care professionals and patients have a set of boundaries and ethics in this therapeutic relationship that must always be adhered to and respected for the safety and integrity of everyone. I absolutely uphold that belief and practice.
In this instance, my friendship with Tsepho began after my work in the surgical ward was done. He was not my patient. He was not a boy I felt ‘sorry’ for and had to support. He was a human being of enormous, unseen specialness and I saw him and cared for him. But more than that, he saw me and cared for me too. It was not a relationship of charity but of raw connection and shared experience. A relationship of “I witness you and what you are going through.” If that is not worth anything in this ‘story’ of life, acknowledgement and connection then I do not know what is.
However you read this story and whatever perspective you take, I was not the gift to him in his life- he was undeniably the gift in mine.
Rest deep in your gentleness, Tsepho – for never are you alone.
