Olifantshoek is a small town in the south-east corner of the Kalahari desert, in a “poort” where a seasonal river flows through. Seasons here are measured in years or decades, not months, but there is enough water so that the town dam only occasionally runs dry. In the Northern Cape and southern Namibia children regularly get to school age without ever having seen rain. In the 1920’s my grandfather was the Dutch Reformed minister in Olifantshoek.
One day in 1922 granddad travelled to Bloemfontein for the church synod. He was a bit of a technophile so he was one of the first in the region to own a car, although he did his parish visits on horseback due to the roughness of the terrain. After the synod he gave a lift home to a Rev Brink from Danielskuil, another small town on the edge of the Kalahari. They got to Danielskuil late afternoon, granddad was treated to an evening meal (the Brinks have always been superb cooks) and offered a bed for the night. He declined as his wife was nearing the end of her pregnancy and he wanted to get home that night. Rev Brink knew of a shortcut along farm roads but this had lots of gates to be opened and closed. He then offered that his six year old son could accompany Rev Dreyer, show him the shortcut and open and close the gates for him. Granddad gladly accepted and they got home by 1 am. And so it was that my future father-in-law helped my grandfather get home to my grandmother, who was expecting my father’s birth any day.
Dad grew up during severe drought and the Runderpest in the 1920’s Great Depression; the only animals still alive in Olifantshoek were donkeys. It was so dry that grandma had to send a bottle round the streets; everyone who had a little bit of donkey milk to spare would put it in the bottle so she would have just enough to feed a future ground-breaking surgeon.
In the 1950s Dad helped to develop potassium cardioplegia for open-heart surgery while working with Sir Ian Aird, got married to Mum in Edinburgh with Dr Davidson (of the internal medicine textbook) as best man, then went back to Cape Town where in 1958 he did the first technical successful heart transplant in the laboratory by swapping two dogs’ hearts; they lived three days until rejection set in. He was invited to join Dr Willem Kolff (who had built the first dialysis machine) in Cleveland, Ohio, to work on the first artificial heart programme. On his return to Cape Town he went back to general surgery because he thought heart surgery was too boring.
First patient, and a decision
It was 1975, somewhere in Southern Angola. I had decided to go for national service because I was not sure what to study. We were pions in a West-East imperialist war for future control of Angola’s riches. We drove into the ambush at dusk and James took a bullet through the ankle. Mark, James and I were lying under the same truck we were in 4 hours earlier. Angolan rain was no joke. We got his boot off; his ankle was getting bigger by the minute, and blue. We had no idea what to do, so gave him 4 Codis tablets and wrapped the ankle so we wouldn’t see the dark blood seeping through, but it looked like toilet paper on a stick. If only we had a proper medic.
The codeine-aspirin combination did not help much for James’ pain, but it made him talk. There was nothing more we could do, but lie next to him to keep him warm. And whisper. The sergeant was on the radio, trying to get an air evac. We knew the chopper pilots would not fly tonight, maybe drunk again. They’re sending an ambulance which will take hours, the road is mined.
At first light the ambulance arrives. James’ leg looks like it will fall off any moment. “Thanks boys” he says, “you’re good to sleep with”. “See you” we said.
We never saw him again but heard that the army doctors saved his leg. “Good outcome” they said. A stiff ankle gets you an honourable discharge for medical reasons. Not a good outcome for a champion 800m athlete. On an Eastern Cape farm you can ride a horse or pick-up truck; there’s no need to run.
The next week I got a message to Dad: “Please confirm that place in medical school, forget engineering”. It took me another 20 years to understand that often we can do nothing for patients except offer them comfort.
It is 1985. Every time I looked at her, she seemed more uncomfortable. Her legs were more swollen every day. Pre-eclampsia is not easy in the tropics but maybe it’s not easy anywhere. It was too late to fly her out to South Africa. After the scare with premature labour at 32 weeks she was not flying anywhere anyway. She was now 38 weeks, “so we made it” we thought. Our baby was going to arrive in a small mission hospital in Nkhoma in the Malawian bush. “Time for an induction”, I said, without thinking much of informed consent. Working amongst so much extreme poverty did not give time for reflection.
With the senior midwife we started her on Pitocin on the Saturday. No contractions followed and the cervix was not yet ready. Should we rupture the membranes or wait? We decided to wait 48 hours.
We tried again Monday morning. By now the blood pressure was borderline high and there was 1+ proteinuria. If the induction fails today she would need a C-section. “Who will do the Caesar”, the midwife asks. “I will” I say, “after all, the others ask me if they have a problem case”. This time she responds well to Pitocin. Within an hour she has good contractions and the membranes rupture spontaneously. I feel for a cord but there is none. Four hours later she is fully dilated. She has a lot of pain. I’m too brusque, so focused on being a doctor that I forget to be a husband and expectant father. She has a boy, 3460g, Apgar score 10/10. I suture the episiotomy; she’s embarrassed. “Don’t worry” I say, “nobody will do this better”.
That night we all slept in the same hospital room, our new son with his mother, our two year old daughter and I on a mattress on the floor. We shared a bathroom with an AIDS patient with resistant malaria, the first HIV positive patient diagnosed in our small hospital.
Today he is 30, has taught in Africa with me, and recently we shared working together in Dumfries. A few weeks before he was born I went to an East Africa surgeons’ meeting and heard Dr Imre Loeffler speak, a Hungarian-Austrian surgeon who gave his whole life to surgery in Africa. He said that a first class surgeon could operate in a hammock slung between two palm trees on a beach and have better outcomes than a second class surgeon working in the most modern theatre. A few months later, when in South Africa to show the new boy to the family, I went to see the prof to get a training post. I started one year later.
Before starting surgical practice in 1992 in Upington, the main town of the Kalahari, I went to see GPs in the region, and that took me to dr Jan Meyer in Olifantshoek. He promised to support me. After our meeting I thought to try and find the old Dutch Reformed manse where Dad had been born 70 years before. Dad’s brother had told me that the building commission drew the house plan in the dust with a stick, and according to that the building started. Now there was a new church and manse, and I opened the gate with the “Pastorie” sign, rang the doorbell and asked the young inhabitants if they knew where the old manse was. Nobody knew. I walked dejectedly to my car and, as I started the engine, an old man walked past; he looked part-Tswana, part-San. I rolled down the window and asked him if he maybe knew where the old NG Kerk Pastorie was. “Oh I know exactly where it is”, he said, “it is the house with a wind pump in the back garden”. I asked him to take me there and he got in, moving very slowly because of rheumatism. It was two blocks down, around the corner in a dusty street, a small little square house, still with a wind pump in the back garden, watering all sorts of vegetables and maize patches. I got out to take a picture. The owner came out and asked what I was doing. When I said my father had been born in the house he showed me round. Afterwards I drove my guide to his house in the old African township and I asked him how he knew the house. “When I was a schoolboy, I used to work there on Saturdays for a Reverend Dreyer”, he said; “He paid my school fees. If it was not for him I would not have been able to read and write”. I stopped the car and we both shed a tear for this generous and humble man whose names I wear with pride.
Jan Meyer kept his promise. The first patient I operated on after setting up practice in Upington was an elderly diabetic from Olifantshoek. His father was the lead elder when my grandfather was appointed minister. Granddad did his catechism and I took out his gallbladder; it was beginning to become gangrenous, typical of a diabetic.
My father and my son have surgical dispositions, much more than I could ever have. When the boy was working in Dumfries, staff kept telling me how he was becoming more like me. That was only half the truth as I was also learning from him. It is when the son not only emulates the father but the father subconsciously starts to emulate the boy that the relationship becomes complete, like my 93 year old father has become dependent on our conversations as much as I once needed his advice. And so we live and learn, love and one day die, in sync and at peace.