I have tried for four weeks to write this post.
It's been difficult.
I feel as if I have an obligation to tell it, but every time I try I don't know how to write it so that it has the most impact. Whichever way, it's a story that needs to be told, because it is the story of many in South Africa.
This is the best I can do...
Despite the 5am darkness and freezing rain, she was grateful for the job that forced her to get up at this hour.
It provided an income, without which she wouldn't be able to clothe and feed her, beautiful 2 year old daughter Zandi*.
Her little sulky Zandi, she's always grumpy at this hour,and protests bitterly at being forced from the warm mattress they share.
She hugs her and speaks softly in Xhosa, 'get up my child, I have to go to work and you must go to the Aunty's house while I'm gone'.
While getting ready in the tin-walled, leaking shack they live in, she worries about her HIV positive status. Yesterday the clinic doctor told her that her cd4 count was low. She didn't really understand because the doctor spoke only English, but she could tell by the way the doctor spoke that this was not a good thing.
Suddenly scared, she offers a silent request to the ancestors that she will stay healthy long enough to support her child into adulthood. After all, there was no-one else to do it.
Her parents were dead and the father of the child just a distant, regrettable memory.
When she moved to Cape Town from the Eastern Cape, it was difficult as a single mother. But luckily she found a job as a domestic worker in Claremont. An old lady in the township offered to look after her child during the day for a fee of 30 rand a week. That lady was a very clever business lady. She looked after many children during the day for 30 rand a week each. No wonder she had a radio AND a TV in her place.
Dropping Zandi at The Aunty's house was always a difficult part of her day, what with Zandi always crying and pleading with her not to go. Today though, Zandi just looked sad and watched her leave with watery eyes. Perhaps she was beginning to accept her daily fate at the Aunty's House. Her daughter looked thin and small standing in the doorway.
But, there was no time to feel guilty, the queues for the taxi's had already started forming and The Madam is always very upset if she arrives late.
The Madam's house was enormous. And her children had so many toys! She spent most of the day cleaning up after them. Scrubbing floors, making beds, washing windows. It was tiring, but she thought of her daughter and persevered.
If she just managed to keep her job and earn enough to send her daughter to school, their luck would turn around. It was her wish that Zandi do better then her, and be the first in her family to get her matric certificate!
Maybe if Zandi got a good matric, she could get a bursary to university! But that would only happen if she had enough money to send her to school and to pay for all the books and school clothes.
While working in the kitchen, her cellphone rang. The Madam had given it to her. It was an old one that her son did not want anymore.
It was The Aunty."Your daughter is not well", she said.
"What is wrong with her?", she asked.
"She is breathing fast, You must take her to the hospital.". And then the line went dead.
The Madam was very upset when she asked to leave early and did not seem to believe her story. But she had to go. She took the train and a taxi back to the township, and eventually after an hour and a half of anxious, worrying thoughts, arrived at The Aunty's house. There she found her little Zandi lying on the floor, eyes wide open and gasping for air...
I arrived at 5pm that day for the start of my night shift. Merely ten minutes into the shift, I noticed a mom walking calmly into the unit with a little bundle in her arms. As I was busy with another patient, I let the Sister do the triage.
The Sister opened the bundle and immediately called for a resuscitation.
I jumped up and ran over to the bed where the little bundle was now placed.
What I saw was an absolutely beautiful two year old girl, neatly dressed in a pretty top and pants, with a little pink jacket and matching little pink shoes.
She looked like a perfect factory-formed little doll.
And just like a doll, she was unresponsive. Only her little respiratory system showed signs of function, when it made one desperate effort and she gasped twice. She had no pulse. I also had to note that her pupils were fixed and dilated.
However she was still warm. Most of the people brought in from outside needing resuscitation have been adults, who were sickly looking and had cool peripheries. This little girl was well-looking and warm, and despite my doctor's senses screaming at me that this girl had a poor prognosis, the fact that she was warm was playing havoc with my mind.
We started the resuscitation. We called all the other doctors to come and help, even those busy in the clinics. I refused to stop. How could we stop when the mother was waiting just outside the door?
Eventually, when it became clear that we were losing the battle for her life, I knew that any more resuscitative efforts would be inhumane and in vain.
So we stopped.
And Zandi died.
Dressed like a doll in her matching pink shoes.
Her mother looked at me with hope and despair as I approached her.
I could do nothing but confirm her nightmare; her little girl had died, despite us trying to do everything. She cried and cried and cried. And I sat with her for half an hour listening to her cry. I refuse to cry when telling the family. It's not fair on them. I'm not the one who lost a child, so I really have no right to burden them with a blubbering doctor on top of everything.
So I just swallow really hard and take a deep breath.
She told me the story of how she had no-one here to support her and that she had no family left. She had moved to Cape Town for better treatment of her HIV, and for a better future for her Zandi. She told me how she ran to the taxi rank with Zandi in her arms, and begged them to let her jump the queue to get to the hospital quicker. She truly believed that Zandi would be ok. But now she had nothing left. I gave her all the money I had with me and let her use my cellphone to call a friend for help.
I finished my shift that night unaffected. After all, there were others waiting to be treated.
But, as soon as I got home the next morning, I remembered the little pink shoes and the waste of a little girl's life. I cried and cried the whole day.
I knew that Zandi was already gone by the time she got to us, and that there was nothing more I could do. The real tragedy lay in the situation of poverty her mother was in. The desperate lady had no recourse but to find a flipping taxi to get to the day hospital, while her child was busy dying in her arms all the way. This is what our patients face.
If Zandi had been born to a rich family, the signs of her illness would have been picked up earlier. The mother would have been able to stay at home and look after her. And if anything happened they would have called their private ambulance or got in their fast car to bring the child speedily to the emergency unit.
And the child would probably have lived.
Now every time I see little pink shoes I can't help but think of Zandi, and be reminded of the tragic situation our nation's poor patients are constantly battling against. It's too sad to contemplate. Mostly I just ignore it in order to function at work. And so far it's been the best way of going about things.
Zandi and her little pink shoes for forced me to open my eyes again and confront the horror.