Book Extract: Like Water For Fish by Garth Japhet, Or Grace Under Blood Pressure

April 23, 2021

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As a child, Garth Japhet stumbled upon the healing power of story – fictional, factual and his own. What magic was at work? If stories had changed him, could he use story to change others? This question set him on the journey described in Like Water Is For Fish (published by Pan Macmillan); a journey that led to Garth co-founding Soul City and Heartlines, and to an understanding that story, in its multiple forms, is as essential for our lives as water is for fish. This extract is published by permission.

It’s 1992 – pre-democracy – and there has been a steady escalation of violence as the ANC and Inkatha jockey for position. It’s worst at night as men go to war – pangas, petrol bombs, guns and knives – in fact anything that can kill or maim and God help you if you get in the way. Sometimes my anxiety is misplaced. Not tonight.

I walk into casualty. Things are quiet. Swing doors open from the street into a well-ordered space permeated by the smell of surgical spirits which tries valiantly to mask the smell of old blood. Ten beds in all. The monotony of the floor-to-ceiling linoleum is broken up by the variety of paraphernalia that make up a casualty unit. Sterile surgical packs mummified in green, trays of needles, syringes and bottles of disinfectant. Drip tubing, IV solutions, scalpels, suture material and oxygen cylinders complete the picture.

I wonder who the sister in charge is tonight. I hope it’s Anna Mokoewena – and it is.

Built broad, powerful and low to the ground, Sister Anna always puts me in mind of a rhino. You don’t want to mess with her … that is, until she smiles. Not many people can frighten a raging man full of drink and blood, but Sister Anna can. Standing her ground firmly, I have seen her wave her formidable fists in such men’s faces. ‘You can choose which one! This one will send you to the mortuary and this one to ICU!’

Sister Anna greets me with her irresistible smile and I smile in return. ‘I have a feeling we will be quiet tonight, doctor,’ she says.

‘From your lips to God’s ears, sister.’ I look around. ‘Have we got students tonight or is it just us?’

Just then two medical students walk in. A young man not shaving yet and a woman who appears to have got out of school early. I’m 28 and I feel old in comparison.

I’ve been doing a weekly night shift for the last two years and when I am able to shelve the terror of the unexpected, I find it exhilarating. Mostly it’s so practical, you can really help the astonishing array of young and old that call Alex home. Dehydrated babies, children with broken limbs and asthma attacks, and the variety of souls that either walk or are carried in with cuts, stabs and gunshot wounds – gifts from Alex.

I mentioned it was quiet tonight. It’s too quiet. It’s 8pm and so far we have only seen a toddler with a high temperature. We sit chatting, snacking on the standard medical fodder of chips and Coke, waiting. Nine o’clock comes and goes. Still no one.

And then it happens. A volley of single shots. We duck. It feels like the gunmen are just outside the door. Then the regular pop-pop escalates into a barrage of sound as if a maniac has been let loose on the drums. I peer out of the window that looks onto the adjacent street. I see people running, their bodies shadowed and lit amber by the shacks that have just been set alight. The doors burst open. Two young men drag their comrade in. His entry is marked by red splashes on the once clean floor.

‘Help him! Now! He has been shot.’

Habit and adrenalin kick in. Sister Anna and I get the man onto the closest bed. She reaches for a pair of scissors and scythes through his designer jacket. ‘Stop!’ shouts one of his friends. ‘That’s his best jacket!’

‘You want us to help him? Then get out of the way.’ Sister Anna doesn’t even have to bare her fists. They back off at her tone and the look she gives them. ‘Mfuwethu – what is your name?’

The young man is pale and unresponsive. His blood pressure is unrecordable and his breathing ragged. He has a single gunshot wound to the chest, a dark hole from hell oozing blood. It always amazes me how some people walk into casualty red-slicked and body in tatters, looking like they have fought off a pride of lions and survived, but a single stab wound or a bullet in the right place can mean death. The bullet has lodged in his lung, destroying vessels in its path, and while he may not appear to be bleeding much, his chest is rapidly filling up with blood, constricting his heart and lungs in the process. Before I have to ask, Sister Anna is already unwrapping the chest drain pack. The two students hover, the young man looking pale. I feel sympathy. Right through med school, I often fainted at the sight of blood.

‘Put up a drip while I work,’ I tell the student. Keeping him busy will help.

Putting in a chest drain in a hurry is not delicate, but it is life saving. By relieving the pressure, it makes it possible for the heart and lungs to function again. I cut through the muscle between the ribs and then stick a metal spike carrying a tube into the chest cavity. Seconds later dark blood pours into the waiting bottle. Breathing eases and blood pressure rises. He should be okay. But this is just the beginning. The sounds of war continue unabated and soon one casualty becomes 50. Men, women and children, some dead and some close to death. Gunshot wounds, burns and stab wounds. Will I ever forget the young girl hacked in the chest, her lung exposed? How, oh Lord, can human beings do this to each other, let alone this poor child? I believe in evil as well as good, but sometimes it’s easier to believe in evil.

Soon we are overwhelmed.

‘Where are the ambulances, sister?’ I ask tersely. We can stabilise patients, but most of them need to get to a proper hospital urgently.

‘They won’t come,’ Sister Anna says. ‘They say it is too dangerous.’

‘The police?’

‘Same story. They won’t come either, and nor will the army. They say they will come in the morning.’

I am gobsmacked. ‘So we are on our own?’

A nod. We get back to work.

The next few hours take me to the brink. We do what we can, but that’s often not much. And then there is my background fear. Only a week back, some thugs had invaded the clinic and tried to finish off a guy before we could save him. Were we about to be invaded again? The sound of glass shattering sends us all to the floor. I look up to see a neat hole in one of the windows. I am scared. Am I a man with too much imagination and too little physical courage? I fear I may be.

Sister Anna summons me. ‘Please come and see this young man, I need your opinion.’

Lying on a bed, eyes closed and not moving, is a young man in his 20s. He looks peaceful, no sign of any injury. Then Sister Anna lifts up his head, revealing a sticky mess of dark matted hair. Gunshot wound to the back of his head. Entry, no exit. His pulse, blood pressure and breathing reasonable. A few years earlier I had done neurology at Baragwanath Hospital so I was pretty good at assessing brain function or the lack of it. In his case it was lack of it. He was alive because of his brainstem, the reptilian part of our brain that keeps us alive, but it was clear that he had massive damage to all his higher functions. If he lived, he would most likely neither walk nor talk again. In the midst of the chaos I make a snap decision. ‘Leave him be.’

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