Confronting Adversity and Finding Grace:
A South African Memoir
John F. Smith, III
In February, 2006, while touring in South Africa, I was seriously injured in a horseback riding accident that took place in a remote part of KwaZulu-Natal Province. Until that trip, I had led a charmed life in my travels. To go overseas was to leave the normal workings of chance and adversity behind. Now, as I lay in a primitive hut with back spasms and internal bleeding – unable to move and, at least for a while, unable to be moved as well – that foolish illusion disappeared in a night of pain and fear. Being hurt and vulnerable in an unfamiliar foreign location, 10,000 miles from home and without access to American medicine, scared me enormously. For the next 24 hours I was not certain how or when I might be able to get to medical care.
As desperate as its first hours were, this lesson in vulnerability was a watershed of sorts. In the days and weeks following the accident, person after person stepped forward to assist my wife and me and to bring me back to health. This memoir describes the journey we made from the village where I was injured to a small hospital in the town of Empangeni, the experiences we had there, and my eventual medical repatriation back to the United States. It is an account of the remarkable people who helped us, the insights that arose out of this shattering – but ultimately transformative – event, and the common humanity that binds our troubled species together.
Whose love and care got me home
Table of Contents
I. Introduction 4
II. A Study Trip to South Africa 7
III. Accident in Zululand 12
IV. Turning Points 26
V. The Empangeni Garden Clinic 29
VI. Faith 41
VII. Recovering from Surgery 44
VIII. Appreciating What Has Been Taken For Granted 55
IX. Friendships and Partings 58
X. Serendipity 69
XI. Repatriation to the United States 71
XII. A Tale of Two Hospitals 77
XIII. Final Reflections 80
It’s an early spring morning in Villanova, Pennsylvania, a university community located near the City of Philadelphia. This is my home. When I wake up, however, I am not in my bedroom. For some reason, I am downstairs in the library. My books, a sofa and several armchairs, a home computer, and our favorite family photographs confirm that I am in comfortable and familiar surroundings. Still, it seems strange to find myself in this room so early in the morning.
It is even stranger to be lying on a hospital bed.
“How did I get here?” I ask myself. “What brought me to this moment?” Then a flash of pain reminds me that I have two incisions, a broken pelvis, and urological damage. I remember now: I have been injured and sent here to recuperate. The library, being on the first floor and close to a bathroom, is a logical place to have put me. It has been outfitted with a hospital bed and a wheelchair and stocked with gauze bandages, tape, hydrogen peroxide, syringes, alcohol wipes, antibiotics, and assorted other medications. It has become a virtual hospital room.
Finally it all comes back: Five weeks before, in late February, 2006, I had a horseback riding accident in South Africa. It took 24 hours to get me to the Empangeni Garden Clinic, a small regional hospital in KwaZulu-Natal Province. Here I had surgery. This was followed by two weeks in the hospital’s surgical ward, and then a difficult 10,000 mile trip back to the United States. Finally, after a brief stay in an American hospital, I was sent home to complete the process of recovery.
It’s April now, but I still have a long way to go. I will lie in this makeshift hospital room under the watchful and caring eye of my wife, Susan, for at least another three weeks.
The pelvis is being held together by stainless steel rods and an “external fixator” that was installed in the South African hospital. I am not to put any body weight on it. My movements, such as they are, are to be by way of crutches or wheelchair. Doctors’ orders. A trapeze or “monkey bar” hangs over the bed. I can use it to shift in position. But I won’t be leaving this place any time soon. For the coming weeks, our library and its incongruous collection of books, furniture, family pictures, hospital bed, and medical supplies will be my world.
Together with the memories. Powerful memories of my experience in South Africa. Memories that have touched me deeply.
I came to South Africa with a group from International House in Philadelphia, an organization whose Board of Trustees I chair. It was to be part study and part vacation. Susan and I decided to make the trip with fifteen International House colleagues and friends in order to understand South Africa’s extraordinary challenges and opportunities. It was to be – and was – an important experience.
When my accident took place toward the end of the tour, however, everything changed. Mine became a living experience, an experience in – not about – Africa. It began in an unanticipated, painful, and unwelcome way, but it had a silver lining. Out of adversity came the unexpected discovery of caring hearts in a foreign land, improbable relationships with extraordinary people, and insights that would not have come in the ordinary course of events.
Looking back on these positive elements later from my library-hospital room in Villanova, I can see that they are much more significant than the unhappy event that preceded them. It is apparent now that they were gifts, gifts that have greatly enriched my life, however accidentally I may have come upon them. This memoir tells the story of my experience in South Africa. In the end, however, it is a celebration of those gifts, and of the inexplicable grace that bestowed them upon me.
II. A Study Trip To South Africa
South Africa! The words conjure up a kaleidoscope of images: the southern tip of a continent, exotic scenery, conflicts between European settlers and native Africans, colonial pride and colonial warfare, gold and diamond mines, the ugliness of apartheid, Nelson Mandela and Desmond Tutu, a new constitution in  and an election in 1994 that electrified the world, outstanding golfers, rising crime, HIV/AIDS.
Every year, International House Philadelphia chooses a country or continent to honor. International House (or “I-House”, as it is popularly known) is a residential facility for international students and a cultural center for the international community in Greater Philadelphia. It is a nearly century-old institution that is devoted to providing multi-cultural programming to the region, promoting international friendship and business activity, and bringing the peoples of the world into closer, more understanding relationships. I have the honor of chairing its Board of Trustees. In 2006, I-House had chosen to celebrate the continent of Africa and to conduct a study tour of South Africa as part of the celebration.
Both Susan and I signed on for the tour. We would be joined by the President of International House, Oliver Franklin, and his wife, our sister- and brother-in-law, Janet and Roger Ritch, by old friends and newer friends, and by one of I-House’s extraordinary staff members. Our group took off from Philadelphia on February 17 and after a re-fueling stop in Senegal landed a day later in Johannesburg.
View of the City of Johannesburg
Johannesburg is not so much an African city as it is a large and cosmopolitan, and intriguing and dangerous, international city. We spent three days in what we soon began to call “Jo-Burg”, touring it and the townships that surround it. We explored the central business district, which has suffered a loss of population and is only slowly reviving. We visited the famous South West Township or Soweto, where the protests of the black community reached such an intensity in the 1970’s and 1980’s that the world was forced to confront the harsh reality of South Africa’s apartheid system. We studied issues ranging from the impact of South Africa’s mining industries to the challenge of replacing the country’s ubiquitous shantytowns with modest but owner-occupied private homes.
Our next stop was Cape Town. Here we took a cable car to the top of Table
View of Cape Town from Table Mountain
Mountain; explored the 17th century fort established by the Dutch East India Company on the tip of Africa; studied the century-long conflict between the Boers and the British; and met with the Right Honourable Paul Boateng, the United Kingdom’s High Commissioner to South Africa.
The International House Study Group with the Right Honorable Paul Boateng,
British High Commissioner to South Africa
Toward the end of our stay in Cape Town, we visited the famous Groot Schuur Hospital. It was at Groot Schuur that Dr. Christian Barnard performed the world’s first heart transplant over thirty years ago. We, however, focused on the gallant fight that is being conducted there today by Dr. Paul Roux against juvenile HIV/AIDS. We were stunned by the information Dr. Roux shared with us - that there are over 25 million cases of HIV/AIDS in Sub-Saharan Africa, that one of every ten sexually-active South Africans is HIV-positive (millions of persons, many of whom are unaware of their infections), and that of the 500,000 or so who have full-blown cases of AIDS, only 100,000 are getting the retro-virals that they need. The impact on South Africa’s children is, of course, devastating. The numbers are almost more than one can absorb. It is hard to grasp their significance. Nevertheless, our group left Groot Schuur convinced that our country must somehow find a way to help address the HIV/AIDS crisis – and the numerous other crises that plague the African continent, ranging from war to famine – or face a continent-wide collapse.
Our tour of the country was scheduled to end with four days in the province of KwaZulu-Natal in the eastern part of South Africa – two days in what is colloquially known as “Zululand” and two days at the Ubizane Game Preserve slightly to the north. These four days would be different, serving as a counterpoint to the experiences we had had to date. They would show us still other facets of this multi-faceted country.
As we began this last phase of our trip on February 25th, I could not know how radically different the next days would be in my case.
III. Accident in Zululand
Our group’s objective on February 25th was a remote Zulu village – or “kraal” – north of the town of Eshowe. It is operated as “Simunye Lodge” and has the status of a National Heritage Site in South Africa. Here we were to enjoy a re-created Zulu experience for two days, a taste of the Nguni culture that has dominated this part of South Africa for centuries.
That morning, we flew from Cape Town to Durban, a large and attractive city on the eastern or Indian Ocean side of South Africa. From there we traveled by bus north and east for two hours to the town of Eshowe. We were now in the heart of KwaZulu-Natal Province. KwaZulu-Natal is large, populous, and impoverished. “KwaZulu” means “Place of the Zulu” in the Zulu language, one of the eleven languages sanctioned in South Africa. The “Natal” in the name of the province is a European contribution. Back in 1497, the great Portuguese explorer Vasco da Gama sailed around the Cape of Good Hope, turned into the Indian Ocean, and continued on up to the subcontinent of India. Along the way, he saw this part of the African continent on Christmas Day. “Natal” is the Portuguese name for Christmas. “KwaZulu-Natal” is therefore a unique blend of the native African and the European influences. It is, one might say, a metaphor for the whole of South Africa.
Zululand. It was in this region that the great warrior Shaka and his tribe made war on neighboring tribes in the early 19th century, conquering them and then conferring upon them the name “Zulu”. The tribes thus conquered were not so much subjugated as they were initiated into a new status. Shaka was a brilliant strategist, and through force of arms and clever psychology was highly successful in his drive to unify the region’s tribes.
Ultimately, the powerful Zulu and successive waves of white men – first the Boers and later the British – fought bloody battles throughout KwaZulu-Natal. One set of combatants and then another gained the upper hand, until the British ultimately prevailed over both the Boers and the Zulus. Each battle site is sacred ground, the location of a glorious victory or an abject defeat, bearing witness to a clash of civilizations, a test of the wills of willful men.
Zulu homes north of Eshowe
By early afternoon on the 25th we had reached the long unpaved road to the Simunye Lodge welcome center. Traveling another ten kilometers along this road, we at last arrived at a low-lying series of one-story sheds with an adjacent corral. This was to be our jumping-off point. The village lay in the valley below, at the bottom of a cliff on the banks of the Mfuli River, some four kilometers distant. We would have to get there by oxcart, in the back of an old four-by-four truck, or on horseback. I didn’t hesitate when given this choice. I consider myself a decent and experienced horseback rider. “Sign me up for a horse,” I said. Susan more sensibly chose the oxcart.
Traveling by ox cart to Simunye Lodge
Our new hosts could not have been more friendly, nor more solicitous of us. They were members of the Biyela clan, an extended family that played a key role in the rise of the Zulu Kingdom in the 19th century. (Although he has no political power today, there is still a Zulu King.) Their job for the next two days was to provide us with a taste of what Zulu life was like a century and half ago. We would be staying in round mud-walled huts with thatched roofs. Except for a common dining area, there would be no electricity. We would witness craft demonstrations and Zulu dances.
First, however, they had to get us there. Our baggage was quickly sorted and loaded, and those who had chosen one mode of transportation or other were segregated into groups. The truck and the oxcart would leave first. The horses would follow later.
Nguli, the chief wrangler, assigned horses to those of us who had chosen to go on horseback. We didn’t have much say in which horse we were to get. Unfortunately, the horse assigned to me was smallish, even bony, and when I climbed up I was surprised to find that the stirrups were of unequal length and size. I adjusted the length of the left-hand stirrup so as to be at the right height. I did not complain of its size, however. This was to prove a fateful omission. I could barely get the toe of my running shoe into it. Oh well, it would be enough. What more would we have than a simple, tourist-friendly trail ride?
The horseback riders preparing to set off
for Simunye Lodge (author in center)
After the truck and oxcart had set off, the party of horse riders followed them down a long, winding dirt track. From the high ground of the welcome center, the vista across the valley was stunningly beautiful. We could see for kilometers in three different directions. Following Nguli’s lead, the horses fell into a easy cadence, with only a small amount of jockeying for position. Swaying in the saddle and chatting with our fellow riders, one was quickly beguiled into a sense of well-being. We were about to enter a new world, the world of the ancient Zulu village, made safe and comfortable for the Western tourist. Demonstrations of village activities lay ahead.
According to the Lodge’s literature, “[w]arriors guide you past towering cliffs and winding rivers into the breathtaking Mfuli Valley where you will find Simunye nestling in the Zulu Heartland.” As we rode along, this description did not seem the slightest bit hyperbolic.
After the first kilometer, the trail grew steeper. Every now and then, the dirt track gave way to a rocky incline. The horses anticipated the rougher stretches and, where possible, avoided them by leaving the trail and walking on a grassy shoulder. However, when such alternatives were not available, there was no choice but to stay with the rocky trail.
As the pitch of the trail turned more sharply downward, it became harder to keep my left toe lodged in its stirrup. This was awkward, because it was necessary to stand back and tall in the stirrups in order to counteract the steep angle of the terrain. I became increasingly annoyed, but there was little to do. We were two, then three, kilometers along. We were only one kilometer shy of the Mfuli River below and the village that lay alongside it. At this point, there was no turning back. No one had a spare stirrup in his pack. I could put up with it. I would have to put up with it.
The party of riders reached another rocky stretch. My right foot was properly planted in its stirrup but my left foot was only tenuously clinging to the stirrup on the left side. I maintained a precarious balance, my torso now standing 15 to 18 inches above and behind the pommel of the saddle.
My horse was picking its way uncertainly. Suddenly, it skidded on the rock face and began to fall forward. As this happened, I instinctively tried to stand still further back in the saddle. This only increased the pressure on the left stirrup, causing my foot to dislodge. My torso hurtled down and forward. In virtually the same instant, catching his footing, my horse reared back against the near fall. With torso falling forward and saddle rising backward, the force of the collision between my crotch and the pommel of the saddle was sizeable. I felt a crushing, painful sensation between my legs. Reacting to the pain, I immediately clutched at the offending pommel like a greenhorn, holding on now for precious support, trying to steady myself, trying to prevent still another thrust of pommel against my privates. I was in agony, but I was determined not to fall.
Miraculously, the horse did not fall completely. Just as miraculously, I stayed on its back.
“Are you all right,” someone said.
“I don’t think so,” I replied.
“Well, we’re almost there.”
“I’ll try to make it.”
The last kilometer of the ride was excruciatingly painful. I grasped the pommel in my right hand and the back of the saddle in my left, doing my utmost to keep my full body weight off the saddle. It was not enough. With each stride of the horse, the area between my legs grew more sensitive. To make matters worse, a series of spasms began. As would later be explained to me, the muscles in the vicinity of my pelvis were making a vain effort to protect it. Each spasm caused a shooting pain in the vicinity of the lower back.
In the meantime, my mind was reeling. I was stunned by the suddenness of this turn of events and my powerlessness to do anything about it. Indeed, there was nothing anyone could do about it at that point. I would have to get to the end of the trail. Then and only then could I dismount. Then and only then there might be relief. Until then, I would have to stay in the saddle, pain or no pain.
The remainder of the ride seemed endless.
The Mfuli River
At last we reached the river, and soon afterward the kraal. Here the horses came to a stop. It was time to dismount, but I found that I was frozen in the saddle. Everyone else got off his or her horse, but I could not. I called for help, and fortunately my brother-in-law, Roger Ritch, and a man called Pieter responded. I motioned them to the right side of the horse. “Catch me, fellas,” I said. Then I leaned over and simply fell into their arms.
Once I was down, it was immediately apparent that my legs would support no weight. I could not walk on my own so these two men, taking me under my arms, half-carried, half-dragged me into the first available hut. It was just as advertised: round, thatch-roofed, and with mud walls, built in the Zulu style. They found a bed near its entrance and laid me down there.
Our hut in the Zulu Village
Fortunately, Susan and I had been assigned to this very hut. Although there were several more huts on this, the side of the stream where the horse riders had dismounted, the rest of the village could only be reached by traversing a wood plank-and-rope catwalk that stretched across the water. People were moving back and forth on this catwalk bridge. There was no way that I could have crossed it, however.
Once set down on the bed in the hut, I lay there immobile. It was dusk. Through the open window I could see fugitive streaks of sunlight on the hills above the village. Down where we were by the streamside, evening already held sway. It was approaching dinnertime. The sun soon abandoned even the highest hills. It was night in Zululand, and in the gathering darkness I lay injured in the re-creation of a tribal village. I began to realize that there was not going to be any quick rescue or change in my circumstances. We were there for at least the night. Despite my usual optimism, my spirits sank to a very low point.
There was no electricity in the hut. I would have to rely instead on the light of a candle that Susan had found and set up near my head. She then disappeared, returning minutes later with a bag of ice from the dining hut to apply wherever it might do the most good. Together we tried to identify the scope of the injury. I could not turn over without assistance. With each move, muscle spasms shot through my lower back. Here was where the ice needed to go first.
We then loosened my clothing, revealing extensive bruising throughout the groin. I felt a need to urinate, but there was no getting to the hut’s tiny bathroom. The only available vessel was a large glass. Despite the back spasms, I turned on my side with Susan’s help and positioned the glass. Nothing came. The urge was great but the spasms were distracting and the “fight or flight” reaction was in full control. Patience. “Leave me alone for a moment,” I asked her. Then it came. A dark rust-red stream. Blood. “Oh, my God,” I said to myself, “blood in the urine. I really am hurt.” For the first time, I became fearful about my condition.
When Susan came back, she saw the red discharge in the glass. Making no comment, she emptied it in the other room. She then came back and did her best to make me comfortable.
Over the next hour, after their supper in the village, the Ritches and the other members of our party stopped by our hut, each concerned for my welfare. One of them had a prescription for Percoset and offered me several tablets. I gratefully accepted. To each visitor I expressed confidence that everything would be well. Beneath the façade, however, I was rattled. Why me? Why now? How did this happen? And how would it end?
One month later, lying in my ersatz hospital room at home, I would not be sure how I passed that night. The Percocet and the ice must have helped. I must have slept some. But my abiding memory is of periodic spasms, of more blood in the urine, of darkening bruises. The entire groin area had turned black. Each hour was one of wakefulness and worry.
Morning came at last, and with it good news. The Simunye Lodge crew had figured out a way to get me out of the valley. They artfully wedged a spare box spring and mattress into the bed of the truck with the four-wheel drive. It would serve as a makeshift ambulance. Roger and several of the Simunye personnel then lifted me up and onto what was now literally the bed of the truck. Susan and Roger got in the cab with the driver. Our friends gathered around and said goodbye. With more bravado than conviction I flashed the thumbs-up sign. The truck then started and we were on our way, retracing in four-wheel drive the precarious route we had come down.
The “ambulance” that took me out of Simunye Lodge
Solicitous of my injuries, the driver picked his way carefully up the ravine. It was a soft and beautiful morning. In contrast to the horror of the preceding night, a certain peacefulness had descended on me. I may have been in shock. In any event, my body was giving itself over to whatever lay ahead. The lurching of the truck brought occasional spasms, but my predominant feeling was one of relief. We were on our way to help.
An ambulance service had been called, but when we arrived at the top no ambulance was waiting for us. They would have to be called again, and there would be a further delay. My confidence sagged again. Who knew how this country thought about time? The wait could be hours. Didn’t the ambulance service understand how much pain I was in? Why hadn’t someone arranged an immediate pickup? These and other self-centered thoughts flooded through my mind.
It was also coming home to me that things had changed in a significant way. I was seriously injured and needed medical care. I was going to be taken to an unknown hospital. If I was lucky, I would be admitted as a patient. If I was truly lucky, they might know what they were doing. But I would no longer be traveling with the group. I would miss the game preserve. The original schedule was now history. Susan and I would be separated from our companions. In a few days, they would fly back to the United States as originally planned. Susan and I would be left behind. The order in our lives had just fallen apart. Our future was indeterminate. It lay in the hands of unknown others in an unknown part of a country that we had entered only ten days before. She and I would be at their mercy.
The ambulance was called again. As a light rain began to fall, one of our Zulu hosts found an umbrella and jumped into the bed of the truck with me. He graciously spread the umbrella to cover me, while leaving himself largely exposed to the rain. As the rain began to fall more steadily, someone produced a new, as-yet-unused mattress, still wrapped in plastic. This was now laid over the cab and the side rails of the truck, forming what amounted to a lean-to to protect me from the elements.
I didn’t know the names of my benefactors as I waited there in the rain for the ambulance to arrive, but I was deeply appreciative of their efforts. These great-great-grandsons of Zulu warriors were considerate human beings. Human beings half a world away from Villanova, Pennsylvania, were caring for me.
When the ambulance finally arrived an hour and one-half later, I was pleasantly surprised to see that it was a real ambulance. It even had the word “AMBULANCE” written in reverse above the front windshield. An efficient crew strapped me into a litter and placed me inside the rear of the ambulance. Our bags were loaded, and Susan and Roger got inside. Both of them would travel with me to the hospital. They would run interference. They would negotiate with whoever might be at the end of my journey. Roger would stay for a day. The tour bus would pick him up the following day, as it headed on up to the Ubizane Game Preserve. Susan would stay behind with me.
Moments later we were off on the two-hour journey to the unknown hospital.
Today, a month later, lying in my hospital bed in Villanova, I remain shocked at the suddenness with which my fortunes changed on February 25, 2006. One minute I was a healthy member of an interesting tour group that had four more days of exploration and adventure ahead of it. The next minute, I was an invalid, lying supine and helpless. One minute I was in charge of my life. The next I was at life’s mercy.
As a species, we are inveterate “control freaks”. Some, like me, are worse than others in this regard, but all of us indulge the notion that with a modicum of effort we can shape what is going on around us. Throughout our lives, we buy goods and fashion homes that are congenial to our life styles. We manage our environment, maximize our pleasure, avoid unhappy outcomes, try to fulfill our dreams. We are often – even usually – successful in these efforts. (We try less successfully to manage the lives of other people, particularly those of our children!) We may not get everything that we would like to have or think we deserve to have, but the American Dream is that if we work hard we will get a lot of it. At the same time, to the extent possible, we seek to handcuff random and hurtful chance by buying insurance against medical problems, fires in our homes, and rear-end collisions. In America, at least, the conceit is that we can shape our tomorrows and make them brighter than our todays.
But however much we try, we can never be certain that some seismic force – shall we call it fate? – will not abruptly take hold of our lives, radically changing their direction. There are numerous example of this that are far more powerful than my own: a tsunami in Indonesia, a terrorist attack in New York and Washington, D.C., a hurricane along the Gulf Coast, a mudslide in Central America, the explosion of an improvised explosive device at a Baghdad checkpoint. All of a sudden lives are shattered. If we survive, our carefully laid plans are thrown out the window.
It is a testament to our abiding need for control that in the wake of such calamities, we often ask ourselves what we might have done differently. If only, we say. If only the U.S. Weather Service had more accurately plotted the path of the storm. If only our intelligence services had connected the dots. If only we had better equipped our fighting vehicles against roadside bombs. If only, to take my homely example, I had not decided to ride that horse down to that Zulu village.
Sometimes, of course, there is little or nothing we or anyone else could have done. We live in a world where we are often blind-sided by events that mere mortals are not in a position to anticipate and avoid. But control freaks that we are, we sometimes ask ourselves if there wasn’t something we could have done differently, something that would have led to a different outcome. Wasn’t there an identifiable decision point, a juncture where one might have calculated the risk differently, at which time one could have chosen a different path? I might have said to myself at the outset of my fateful horseback ride, for example, that it’s going to be too dangerous to get on this horse, that I’ll take the oxcart instead.
Hindsight is twenty-twenty, as they say.
But there are limits – even dangers of a sort – in this kind of retrospective analysis. This was illustrated by a comment that one of my sons made shortly after I had been repatriated from South Africa to the United States. I was in the University of Pennsylvania Medical Center for several days of evaluation. My sons came to greet me at the hospital, to learn what had happened, and to make sure that the old man was going to pull through. I gave them an account of my accident and the events that followed, Then I said that I wished I had never gotten on that horse, that I had never gone horseback riding in South Africa. This seemed a reasonable enough statement under the circumstances. It brought a sharp rebuke, however, from one of the boys. He would have none of it. “Don’t say that, Dad, “he reproved. “If you weren’t the sort of person who was open to an adventure like that and getting up on that horse like you did, think of all of the other experiences in your life that you would have missed. You wouldn’t be the person I know who loves life and its adventures. You wouldn’t be the person I love and respect.” I was momentarily taken aback by the sharpness of this remark. Moments later, however, its profound correctness became clear: we are not born always to play it safe. Part of the joy of life is in our willingness to venture upon things that might not always turn out well. It pays to think our choices through, but not to parse them to the “n”-th degree. We can’t always control our outcomes. Our willingness to plow ahead regardless may be what makes us human, allowing us to become a vibrant, insatiably curious and highly successful species with an unquenchable penchant for innovation and improvement. We often pay a price for this intrepidity, but without it where would humanity be?
V. The Empangeni Garden Clinic
The town of Empangeni lies on the eastern side of South Africa, just off the N2 highway and inland from its twin town on the Indian Ocean, Richard’s Bay. Seldom visited by American tourists, it is a community of roughly 24,000. There is a shopping mall in Empangeni; a decent hotel with lovely gardens, the Protea Empangeni; and a private hospital, the Empangeni Garden Clinic.
The Empangeni Garden Clinic turned out to be the destination of the ambulance that had picked me up. After traversing the long and pot-holed dirt road from Simunye Lodge, the ambulance traveled for nearly 100 kilometers on secondary roads, arriving in Empangeni about two hours later. I must have gone in and out of consciousness, for I have little or no recollection of the ride.
Fortunately, the ambulance team passed up a smaller facility along the way. My condition was marginal, and it would have lacked the remarkably sophisticated, multi-disciplinary resources that were available at the “clinic” in Empangeni.
The word “clinic” does not begin to do the Empangeni Garden Clinic (“EGC”) justice. This facility, originally part of the Afrock chain of hospitals in South Africa and now part of the Life Healthcare group, is a complete hospital with 107 beds. There are four surgical “theatres”, a surgical ward with beds for 28 patients (14 male and 14 female), a general ward, a pediatric ward, an ICU (called the “High Care” Unit), a radiology department, a dental surgery department, an emergency room, and accompanying administrative offices. Its medical staff are highly trained. The hospital is a training facility for nurses.
The Empangeni Garden Clinic
The clinic has a large number of personnel on its nursing staff. It is, moreover, a melting pot in which the descendants of Zulu tribesmen, Dutch Boers, Huguenot refugees, British colonists, and Indian immigrants work together under one roof. The staff speak English, Afrikaans, and Zulu, sometimes in the same sentence. On many levels, it is an extraordinary place.
When my ambulance pulled up to the Emergency Room entrance, I knew none of these things, of course. I was a stranger in a strange land, whose body was broken and whose mind had conjured up the unspoken fear that my condition was grave and would be well beyond the level of help that might be available in this out-of-the-way place. It was now Sunday afternoon, February 26th. A full 24 hours had passed since the accident. I was in pain and I was apprehensive, buoyed only by the presence of my wife and my brother-in-law. Thank God they were with me – to attend to the administrative issues of being admitted to a hospital, to look after any number of personal issues as I lay in the Emergency Room, to calm me simply by their presence. The back spasms continued, however, and I remained in a state of high anxiety about my medical condition, particularly the blood in my urine.
Thankfully there was very little in the way of bureaucracy in this place. I was quickly seen by Dr. Adetiba, who had the ER duty that Sunday. He sized up my condition and quickly ordered an x-ray of my pelvis. He called for an orthopedic surgeon and a urologist to examine me. He appeared professional and efficient.
A short while later, a Dr. Sailesh Ragoo arrived. The orthopedic surgeon. He examined me, then looked at the x-rays. He asked me some questions about the accident, how I was feeling, where I was experiencing pain. He was straightforward and incisive.
I had suffered an “open book” fracture of the pelvis, he said. The sharp muscle spasms that I was experiencing were the result of the body’s internal mechanisms for protecting the broken pelvis. He was, however, uncertain about the extent of the urological damage. This, of course, was the “blood in the urine” issue. I was fixated on it. What could anyone do until the urologist arrived?
It suddenly occurred to me that I knew a urologist. In the United States, of course. As irrational as the thought was, all I had to do was get him on the telephone, my telephone, my “Blackberry” with its cell phone capability. I knew by heart the number of our family friend and respected urologist, George Drach and his wife Peggy Duckett. If my cell phone had a signal here in Empnageni, I could try to reach George. I needed to reach him. I would call the number and see. And so, from a distance of some 10,000 miles – half way around the world – lying on my side in a South African emergency room, experiencing ongoing spasms and desperate to hear a friendly, knowledgeable voice, I punched the numbers into the phone and held my breath.
“Hello” a sleepy voice answered.
“Peggy, it’s me, John Smith. I’m calling you from South Africa. I don’t know what hour it is where you are. Please just don’t hang up. This is an emergency.”
“John, are you okay?”
“I’m in South Africa and I’ve been hurt and I need to talk with George. Peggy, is George there?”
A moment of silence, and then George’s wonderfully reassuring voice came on the phone.
“John, what’s happened to you?”
I told him, then turned to Dr. Ragoo. “Doctor, I said, “I have a prominent American urologist on the telephone. Could you talk with him?” Dr. Ragoo took the phone in hand, and there then began one of the most unusual – and certainly most abrupt – medical consultations ever held. Ragoo and Drach spoke for seven or eight minutes. After discussing the matter, the two doctors concluded that I probably had a partial tear of the urethra, up toward the bladder, but that, subject to further testing, it was not likely to be worse. This would of course have to be reassessed by the staff urologist, but it was enough for now. I took the phone back and once again heard George’s comforting voice:
“You’re going to get through this,” he said. “Your doctor knows what he is doing. Keep me up to date as you go along.”
“Thanks, dear friend.”
It was a small but powerful example of the uses of modern telecommunication. Two doctors from entirely different backgrounds, one of whom was in a South African Emergency Room and the other of whom was in his bedroom in Philadelphia, communicated with one another half a world apart, compared notes, came to a tentative conclusion, and proceeded to allay the fear – if not the pain – of their grateful patient. Dr. Louis Fourie, EGC’s urbane and highly skilled staff urologist, would soon take over and refine the urological diagnosis, but for the moment I had the positive message I needed. Blood or no blood in the urine, I was going to live.
Now my body needed to be stabilized. Dr. Ragoo told me that he was sending me to the High Care Unit where my functions could be monitored around the clock. There would be no operation tomorrow (Monday). I would instead have more x-rays and tests, and he would consult with Dr. Fourie in depth about my urological condition. Together they would then formulate an appropriate surgical plan.
And so I was wheeled off to High Care. There I was given an intravenous drip and hooked up to a wide variety of monitors. It seemed, in fact, that I was now attached to every medical monitoring device known to modern medicine. (It half occurred to me that this was the hospital’s way of saying to its skeptical American patient, “Look, we may be out of the way on the east coast of Africa, but don’t think that we’re not up to date in our medical technology.”)
A nurse attendant named Josiah was responsible for my care. It was cold in High Care. Perhaps it is cold in every ICU. I told him that I was freezing and he brought me an extra blanket. It was Josiah’s job to look after me in every respect: provide my oral medications, administer pain-killers, give me injections to prevent clotting and the possibility of an embolism, monitor my vital signs, get beverages for me to drink, somehow make me comfortable amid all of the wires and tubes. He was the most gentle of souls. Whenever he administered an injection, he always uttered the word “sorry” in a soft tone. Throughout a very long night he did his utmost to serve his patient.
Mercifully, the painkillers were powerful. I told Josiah that I had had bouts of nausea when I was given strong narcotics in the past. He told me that I could have an “anti-nausea” shot to counterbalance the effect of the narcotic. I asked for the anti-nausea shot and made it a point to ask for it each time a painkiller was given to me afterward. It became a little joke for the staff. A nurse would say it was time for my pain-killer injection (“sorry”). I would raise my hand, only to have the nurse take the words out of my mouth: “and of course for your anti-nausea injection as well.” The second syringe would then be promptly administered. (Again: “sorry.”)
Josiah’s ministrations nothwithstanding, I did not sleep much that night either. Too many monitors. Too many ways to be uncomfortable. Too little warmth. When I awoke in the morning, I was relieved to learn that I would be transferred to the Surgical Ward later in the day. I would be closely monitored there, but would have fewer gadgets attached to me. And the temperatures in the Surgical Ward were not sub-zero!
I was accordingly transferred to the Surgical Ward on the morning of February 27, 2006. My stabilization would continue here, and the operation would be performed the following day. Transferring to the Surgical Ward was a good thing for a lot of reasons. It was comfortable. They were used to prepping people for surgery. And, although I could hardly know it at the time, it was in the Surgical Ward that I would later make some very good friends.
Best of all, Susan was there waiting for me in my new room. She had spent the previous night at the Protea Hotel two kilometers away in the Town of Empangeni, along with Roger Ritch. Roger had come to the Surgical Ward, too, and would stay with us for several more hours, until the Tour Bus came by to pick him up.
I was largely helpless when I arrived. On this first day in the Surgical Ward, I had frequent small needs that I could not meet myself. My throat was parched and I needed water. I would spill something and my sheets would need changing. I needed a bath. By virtue of this multiplicity of minor requirements and the sheer number of nursing personnel on the staff, I had numerous dealings with them. Indeed, as a person who likes things just so, I needed them often. But I also worked hard at not being a demanding patient. Although they were there to serve me, I had to be careful not to wear out my welcome. Accumulating and packaging small bundles of requests that could be met at one time helped. So did a sense of humor. The greatest lubricant in our relationships, however, was more old-fashioned: a genuine interest in getting to know the other person. Over time this was to pay very real dividends for me and, I think, the staff as well.
The day before surgery is one of consultations, tests, and visits to the radiologist. My day was full of these things. Dr. Ragoo called on me in the course of his rounds, and explained the plan of action that he had developed. I was to have four metal rods or “pins” inserted in the front of my pelvis. To these pins would be attached an “external fixator”, a metal apparatus that would fit onto the pins and, once so anchored, would be used to bring the pelvis back together. It would close the gap in the front of my pelvis (the “pubis synthesis”) and hold the pelvis in place until the fractured sacroiliac joints – which lay at the rear of the pelvis and had cracked when the book of the pelvis “opened” – could heal over with scar tissue. The fixator would stay in place until the cracked joints had healed, or at least until an internal plate could be installed that would do the same thing.
The immediate installation of such an internal plate was not indicated, Ragoo said, because the hematoma (bruising) in the pelvis area was too great. To cut into such a bruised area is to take a great medical risk. The external fixator, anchored by pins on either side, was therefore the way to go. His presentation was lucid and to the point. I felt entirely comfortable with the plan of action, and so did Susan.
Dr. Fourie also visited me during the day. Dr. Ragoo would be the lead, he said, but he would work with Ragoo and examine the urological situation while I was in surgery. Fourie was an elegant and somewhat more formal man, but he engendered the same confidence in us that Ragoo had.
Not everything was confidence-building. There were more x-rays to be taken. In the early afternoon of the 27th, I was wheeled out of my room and taken down to Radiology. Radiology was apparently not ready. My attendant parked my bed outside in the hallway, with my face to the wall. Then, instead of letting me know what the situation was, he left without a word of explanation. I was now alone in the hallway. A half hour passed, then a hour, without any word. People and other beds periodically passed by without any acknowledgement of my existence, much less my growing sense of frustration. I began to feel that I had been abandoned. Facing the wall, I had little to look at beside the patterns of paint that had long ago been left behind by a roller brush. I tried to occupy my mind with these patterns. Some resembled constellations of stars in the sky. One was possibly like Cassiopeia’s Chair. Another half hour went by. Still no word. I was becoming really frustrated. Doubts about the facility and its efficiency crept back in. Perhaps this was not going to go that well, I said to myself.
It was pathetic, really. Witness John Smith, presumptuous and self-important American lawyer, lying on a bed in a South African clinic, wrapped in the anonymity of a hospital blanket, going quietly mad with the interpretation of paint patterns, and thinking that he had now been forgotten by Radiology, the entire hospital staff, and most likely the rest of the world as well.
“Excuse me, Miss,” I at last called out to a passerby. “Can you tell me when they will take me in The Radiology?” She was in Accounting and had nothing to do with Radiology. I turned back to my ersatz constellations. By squinting hard, one could make out the Big Dipper. Or was it something else?
“Ready for you now, Mr. Smith,” came the cheerful greeting. “Had a long case before you, I’m afraid. We’re all set now.”
With these words, I was at last ushered into Radiology. The technician proceeded to do her job efficiently and well, and I was soon returned to the Surgical Ward.
So what had happened? I had had to wait my turn. That was all. Was I smart enough to realize that, while I might be at the center of my own universe, I was not at the center of everyone else’s? Get used to it, John. You are one of several billions on this planet. Some of those others can and will be served before you.
Sometime afterwards, the Tour Bus arrived to pick Roger back up. I hated to see him go, but was glad that he could rejoin the others and have a chance to see the big game up at Ubizane. There were hellos and goodbyes, and promises to return two days later when the visit to the game preserve would have ended and the group would be heading down to Durban to start their trip home.
As the afternoon wore on, the nurses were in my room more frequently. There were more tests to be performed. They listened to my breathing. I was given an EKG. The monitoring of vital signs continued. There were consent forms to sign. I was asked at least a dozen times whether I was allergic to anything. No, I said.
By the end of the day, Susan was exhausted. She had been up with me much of the night following the accident at Simunye Lodge. Twenty-four hours later she spent another restless night, our first night in Empangeni, in the unfamiliar Hotel Protea. Now, on the 27th, she had been with me all day. Night was falling. Roger had left, and for a woman to be outside alone after dark was to invite trouble. It was important that she get a taxicab back to her hotel and get some sleep. Tomorrow would be the day of my operation.
Neither of us had much of an appetite. We shared my hospital dinner largely in silence. Then a kiss and squeezing of hands and she was off. Not long afterward, I was given my evening “meds” and a sleeping pill. I was asleep by 9 p.m.
My second night in the hospital was not as bad as the first. The sleeping pill must have done its job. And the injection of pain-killers (“with the anti-nausea injection, too, please”) didn’t hurt. I at least got to sleep for several hours. But the muscle spasms continued. I asked for more painkillers and this got me to four a.m. Then I became too wakeful to sleep. My mind was filled the operation that lay ahead today. Would everyone know what they were doing? Would my pain wake me up in the middle of the procedure? What would the fixator look like? Would everything go all right? There was now little to do but wait and pass the remaining hours until daylight as best I could.
The arrival of a nurse with the heart rate and blood pressure monitoring machine at 7 a.m. signaled the official beginning of the day. She took her readings and left. Now it was time for my bath and the changing of the sheets on my bed.
Bathing is surely one of humankind’s most satisfying pleasures. In my case, the constraints were severe, of course. I was flat on my back and unable to move without assistance. There would be no commodious tub full of steaming hot water, no shower head to stand under. It would be only a sponge bath. Even so, after making all of the needed allowances, it was to be my most satisfying experience in days.
As a technical matter, bathing me on the hospital bed was an intricate matter, one that took at least two and occasionally more nurses to accomplish. There were bowls of warm water and soap. There were washcloths and towels. There were, in succession, the soaping, the rinsing, and the drying processes. To turn the body of someone in my condition required a “draw sheet” placed transversely under the pelvis, two or three pairs of strong hands, and good team coordination. I could not move myself at that point and was therefore incapable of assisting them. Even the slightest twisting produced the excruciating spasms. And yet somehow they managed. All of this was followed by the changing of the sheets. Having rolled me to the left with the draw sheet, it was possible to remove the old and then put a new bottom sheet on the right side of the bed. The other side of the sheet was then tucked under my body. Then the draw sheet was utilized once again. Expertly rolling me to the right this time, the nurses gained access to the edge of the sheet that had been tucked under me. That could then be pulled through and, after removing the rest of the old sheet, could be tucked under the mattress. The nurses accomplished all of this with practiced skill and gentle humor. It was, altogether, a choreographic tour de force. The net result: a clean body lying on a clean sheet. Making up the rest of the bed was relatively easy, as was getting me into a fresh hospital gown. I felt briefly like a new person. Baths, even sponge baths, can do that for you.
When the morning bath was over, however, it was back to waiting. Again my anxieties returned. The hands of the clock trudged slowly around the dial.
After what seemed like hours, a pair of orderlies arrived at the door of my room. “We will take you to theatre now”, one of them said. This was Wiseman Ngema, a tall muscular man with a deep voice and vaguely sad eyes. They unlocked the wheels of my hospital bed and rolled me out into the corridor. The surgical wing was down a couple of bays from the Surgical Ward. I was wheeled down the corridor and a minute later into the operating room.
Upon arrival in the OR, I was impressed with its bright cleanly appearance and the modernity of its equipment. Several nurses were there preparing for the procedure. I assumed that Drs. Ragoo and Fourie were somewhere nearby. My fate was in their hands. Two days ago I had met neither of these men and was completely unaware of the existence of the Empangeni Garden Clinic. Even today, the day of the operation, despite good first impressions, I had virtually no information regarding their professional skill. I would have to take it on faith. There was no other choice.
The anesthesiologist, a Dr. Dennis, greeted me and promised me a good rest. Several minutes later, he gave me an injection. I lost consciousness quickly.
Issues of faith, spiritual and secular, spoken and unspoken, weave through everyone’s life. They certainly wove through mine in a quick and complicated tangle as I headed to my date with Dr. Ragoo in “theatre”.
The word “faith” can be traced back to Middle English and Old French antecedents that are related to the Latin fides or fidere, to trust. The most common usage comes in the context of religion. Here it can be defined as “the act or state of wholeheartedly and steadfastly believing in the existence, power, and benevolence of a supreme being, of having confidence in his providential care, and of being loyal to his will as revealed or believed in.” (Webster’s Third New International Dictionary – Unabridged) From a secular viewpoint, Webster’s defines faith as “confidence, especially firm or unquestioning trust or confidence in the value, power, or efficacy of something” as in “faith in his medical skill.” This latter definition probably comes a little closer to the kind of faith that I was hoping to have as I was being wheeled into the operating room. My fear of dying had largely quieted down by now, and I was therefore not quite as concerned as I had been about the fate of my immortal soul. I was, however, very concerned about how well Dr. Ragoo and his colleagues would perform their duties. What my condition might be after the procedure was very much on my mind.
Ambrose Beirce, the sardonic short story writer and journalist who wrote in the late 19th and early 20th century, had little patience with the religious notion of faith. In his famous work The Devil’s Dictionary, he defined it as follows:
“Faith, n. Belief without evidence in what is told by one who
speaks without knowledge, of things without parallel.”
Beirce did not trouble himself to address the secular notion of faith, but he might well have asked what basis I had for my faith in the surgeons and operating room personnel of the Empangeni Garden Clinic.
What did I know after all? That something that looked like a real ambulance had brought me there. That the driver seemed to know where he was going. That the facility looked like a hospital and had patients like me. That Dr. Ragoo, and later Dr. Fourie, gave good accounts of themselves, and the nurses were caring. And that my friend and experienced urologist George Drach had pronounced Ragoo as competent, although it was hard to determine how he had divined that from 10,000 miles away in an eight minute telephone call. The truth, therefore, was that I really knew very little. And I had a considerable number of lingering reservations. It would be hard to describe me as having “unquestioning trust or confidence” in the surgery that I was about to undergo.
But there was no choosing to be done. I was hurt, I had been taken here, these people seemed to know what they were about, and no immediate alternative was in sight. One must assess a course of action in the context of the circumstances with which one is presented. My options were few and this one seemed the best available. Uncertainty remained, but one had to go forward.
I live with both convictions and doubts in my religious life. I hold fast to certain principles that my mind, powerful yearnings, and years of living have persuaded me of. But I lack many of the answers that I seek. I suspect that this condition will continue despite all of my earnest seeking and that I shall ultimately die in a state of uncertainty about many things, including what may or may not lie ahead for my soul. And yet I must live my life, put one foot in front of the other, choose directions in which to go, and make fateful choices, all notwithstanding that uncertainty.
My father once described religion as the way we give ourselves to the very best we know. Not what we’re sure of. Just the very best we know. This knowledge, even the best of it, will be forever incomplete. And yet what we must go forward on the basis of this incomplete knowledge. Indeed, if we consider ourselves to be religious people, we must somehow give ourselves to it. This can be as frightening as hell, this undertaking of life commitments on the basis of less than all of the evidence, this giving of ourselves in the face of uncertainty. It takes guts. It takes faith.
So, on a much more modest level, as uncertain as I was, I had “faith” in Dr. Ragoo and Dr. Fourie and their team. It only remained to be seen if that faith would be rewarded.
VII. Recovering From Surgery
I was back in the Surgical Ward when I awoke from the surgery. It took a long while for my head to clear. I was vaguely aware that Susan was there in my room. She later said that I drifted in and out of consciousness for several hours.
My intravenous drip was in place. For the next six days it would continue to be the principal means for keeping me hydrated and getting things like painkillers and anti-coagulants into my system quickly. But I was still thirsty. Oh, so thirsty! There was a pitcher of apple juice on the table next to my bed. Susan poured me a glass. I looked at it greedily, trying to figure out how I was going to get it into my mouth. It was going to be a chore. I could still hardly move myself. I couldn’t raise myself high enough. I would have to rely on a straw bent in the middle to reach my mouth (there were no hospital straws to be found). But a bent straw is a frustrating device, one that is hard to get any liquid through. Well, maybe I could get up part way on an elbow. This was painful, but worth it. I drank deeply.
My thirst having been slaked, I looked down at my waist for the first time since the operation. There it was. The fixator. A combination of black and silver metal, held together tightly with a screw that could be loosened or tightened with an Allen wrench, and supported by four shiny steel rods that grew out of my waist. The fixator was at once an intrusive presence and a neat, almost attractive, piece of hardware.
Both sets of rods or pins were heavily bandaged where they came out of my waist. I could not see the place where they pushed through the skin. The fixator was now part of my reality, however. My ability to turn over would now be doubly limited, first by the pain, and second by the pins.
Supper came at 5:30 p.m. sharp. I had only a small appetite, and Susan and I shared the meal as we had the evening before. There was an ample amount given our limited interest in food. Then it was 7 p.m., time once again for Susan to get back to her hotel before night fell.
It was difficult to find a comfortable position in bed that night. I was exquisitely aware of the fixator and the limits that it imposed. The nurses helped me prop up several pillows in strategic spots. This helped a little. Once again, I would have to rely on the sleeping pill and the painkillers. Nevertheless, I had to ring the call button and get still more painkillers through the night.
After a restless sleep, I awoke at 4:30 a.m. on the 1st of March. Further sleep didn’t seem likely. Instead I lay there thinking about the events of the last two days. By five thirty I realized that I was thirsty and had a dull headache.
I rang the call button and two minutes later an angel of mercy disguised a nurse arrived.
“Could you get me something to drink?”
“What would you like?” she said. “Can I get you a cup of tea?”
Few suggestions have been made to me in my life that have been so timely or instantly welcome that early in the morning. Of course, I thought to myself, a cup of tea! Perfect!
“Yes, I’d like that,” I said.
What arrived several minutes later exceeded all of my expectations. It began with a round metal tray. On a doily located in the center of the tray was a small kettle of piping hot water and a china cup, together with a large tea bag, a small creamer, and three sugars. And a sweet biscuit! Propping myself up on one elbow without exciting another round of spasms took some careful maneuvering, but I readily accomplished this task. I had never had a more beguiling incentive to get up! After fumbling for a while with the implements provided, I managed to steep and pour the tea and to add and stir in the cream and sugar. The first sip was stingingly hot but incredibly refreshing. The sweet biscuit melted in my mouth. I drained the cup, and a feeling of utter well-being washed over me. My pain was forgotten, at least momentarily!
Over the course of the next several days I began to understand more about the nursing hierarchy at the Empangeni Garden Clinic. This hierarchy begins at the basic “Care Giver” level, then ascends by degrees through various intermediate levels, including “Staff Nurse” and “Enrolled Nursing Auxiliary”, to the top rank of “Sister”. The title of Sister has no religious significance. The hospital is not religiously affiliated. But a Sister is the equivalent of a Registered Nurse in the United States and is given enormous respect. And in the world of the Surgical Ward, Sister Kirsten Bradley stood above all of the others. Bright, highly skilled, and authoritative, and possessed of a wicked sense of humor, she was the Unit Manager and what she said went.
The most basic services were performed by the Care Givers. They bathed the patients, helped them brush their teeth, turned them over, changed the bed linen, brought water and juices and cups of tea, and answered the call button. In general, they performed the myriad of small services that make a patient’s life bearable. Personnel at one of the intermediate levels installed saline drips, took readings of one’s vital signs, doled out medications, and gave injections. The Sisters dealt with the most sophisticated tasks, assisting physicians on rounds, changing dressings, and addressing unusual requests and situations.
As a group, the Care Givers were young, funny, and without pretense. They wore their hopes and dreams – and their occasional issues – on their sleeves. With a small amount of coaxing, they readily shared these things with us. There was Elaine, a 22 year old descendant of Boers, who had ambivalent feelings about her marriage. Her husband was not holding up his part of the economic bargain, she complained. Elaine took excellent care of me, chatting all the while about her joys and woes. Devoted to her duties during the day, she could hardly wait to go back to her pretty two-year old daughter at the end of her shift. There was Johanna, who on her day off arrived in a lime-green evening dress, headed to a party with her husband, Don. All decked out, Johanna and Don came by to say hello and commiserate with me. There were Carol, about whom more later, Gloria, and Hlengiwe, who had a devil of a time trying to teach me to pronounce her name.
And finally, there were Celine and Rachel, who seemed to operate as a pair. Celine was a “coloured” with a strong Zulu heritage. A little probing and it developed that she was an aspiring singer. The others kidded her, calling her Celine Dione. Together with her father and brother, she was hoping to conclude a contract to perform at a new hotel in the region. Rachel was most likely the descendant of British colonists. Now she was Celine’s best friend and mischievous co-conspirator. The two of them were delightful together. (I once described the pair to Sister Bradley – in their presence – as a model of how Care Givers should perform. Sister’s response, given lovingly and with one eyebrow arched: “Who do you mean? These two little shits?”).
With Cynthia, a Nurse in Training, and Elaine, a Care Giver
The nurses higher up in the progression were equally interesting: Cynthia, conscientious Cynthia, who was studying to move up in the ranks of nursing; Gerda, also studying to move up, who was a diehard fan of “Survivor” and “The Great American Race”; Gugu and Sheilah, who faithfully brought me my meds; and Anne-Marie, who was hard-working, accommodating, and practical. The Sisters at the top, some of whom appear elsewhere in this account, were all highly professional.
I found each of them fascinating.
They found us interesting, too. What did I do? What is it like in the States? Is Mrs. Smith liking Empangeni? We learned to kid each other and enjoy each other’s company. It soon became clear that despite the feeling of abandonment and anonymity that I had briefly experienced outside of Radiology two days before, quite the opposite was true. Americans were very rarely patients at the Clinic. Susan and I were something of a phenomenon.
I think that everyone came to relish the relationships that developed among us.
March 1st was our tour group’s last day in South Africa. They would be coming down the N1 after their visit to the Ubizane Game Preserve, heading for Durban and the flight home. This would take them close to Empangeni. Concerned for my welfare, they diverted from the highway and late in the morning arrived at the hospital. It was the high point of my day. We had developed good friendships with one another, and my accident only served to deepen them. Two by two, they came in to say hello and goodbye. We stretched the visiting hours policy of the hospital almost to the breaking point, making the most of a bittersweet moment for all of us. Then they were gone, en route home.
Their departure was another low moment for me. From this point forward it would be just Susan and me. We were again alone, left to fend for ourselves in a remote corner of South Africa.
Looking beyond my own situation, I was concerned for Susan. I had an array of nursing personnel whose job was to look after me twenty-four hours a day. She had no one, excepting a disabled, bed-ridden husband. I was in a completely secure environment. She had to travel through a troubled community to her hotel and back. When she returned to the hotel after an evening, she was all alone. It seemed unfair. I was a patient and the object of medical attention; she was a quasi-care giver with no one assigned to care for her.
Happily, Susan has a remarkable facility for making friends. The nursing staff loved her. Her cab driver (Jacques) and his wife (Adele) became devoted to her. Two of the hospital administrators, Belinda Naude and Pauline Pieterse, took her under their wing, and the three of them promptly planned a day trip together for later in the week. Jacques’ wife, Adele, promised to go shopping with her, and later Jacques and Adele would take her up for a visit to another famous game preserve, Hluehluewe. I could relax a little. This was a remarkable woman. People drew around her in this time of need. She would be all right.
In the ensuing days, I made a little progress each day. The pelvis was no longer unstable, and the muscle spasms gradually subsided. I slept more comfortably (although turning over was still a chore). I had become accustomed to the strange metallic apparatus that protruded from my abdomen. I fell into a routine in which the morning bath, Susan’s arrival, and the meals were the highlights, together with the daily visits of Dr. Ragoo and Dr. Fouric. Their reports were generally upbeat, and helped to elevate my mood.
Dr. Ragoo, Sister Bradley, and patient
A series of physiotherapy sessions began two days later. I learned a variety of simple leg and foot exercises. These, together with the anti-coagulation shots I was receiving, would be an important prophylactic against an embolism. Given my injury, the surgery, and my relative immobility, there was a substantial risk of clotting. The trick was to protect against the formulation of blood clots while not encouraging excessive post-operative bleeding. The shots were part of the strategy. The exercises were another. I listened to the physiotherapist and dutifully practiced my exercises each day.
One afternoon I learned that a bet had been made by a Care Giver named Carol with three of the other Care Givers. It involved me, and chocolate candies were riding on the result. Elaine, who was one of the persons who had taken Carol’s bet, approached me regarding the wager. It appeared that Carol was convinced that she had seen me on TV, indeed, that I had starred on the second installment of the reality show called “Survivor”. Elaine and the others had their doubts. What was the truth, said Elaine. I knew that Carol was going to be disappointed. I had never been on that show. Trying to soften the news, however, I responded by first mentioning the handful of relatively minor appearances that I had made on TV (none of them having anything to do with “Survivor”). I then mentioned the survival training school I had attended in the Philippines before heading off to a tour of duty in Vietnam. That was a form of “Survivor”, wasn’t it? Elaine wasn’t buying these temporizing comments. “Come on,” she said. “Just answer the question.” Then, at last, I acknowledged that I had never appeared on “Survivor”. A smile appeared on Elaine’s face. She had won the bet, as had two others. As she left in triumph, I knew that my answers, however carefully couched, had cost Carol some chocolates. I liked them all and hated to see even one disappointed. Sorry, Carol.
The Blackberry remained an invaluable resource, and I made frequent use of it to update family, friends, and business colleagues regarding my accident and treatment. I had sent messages to our sons John, Stephen, and Peter early on and they immediately and frequently responded with great concern for me. They took to calling me every day at 9 a.m. their time, 4 p.m. in Empangeni. It was wonderful to hear their voices and to know that they were rallying around.
Susan, too, became a Blackberry fan. She dived into using it with the same enthusiasm that she has for her email correspondence on our computer at home. The Blackberry’s telephone feature continued to work as well as it had on the night of my admission to the hospital. Several of our friends and business colleagues were startled to get phone calls from bedside. This small device became our communications workhorse, and numerous family members, friends, and colleagues were enlisted to relay our news to the rest of our small universe. I shuddered to think what the roaming charges were going to be. But no matter. The ability to communicate – to allay the concerns of our loved ones – was truly invaluable.
A new Blackberry fan
Come the weekend of March 4 and 5, Dr. Ragoo left to attend a conference in Johannesburg. In his absence, I was visited by two of his orthopedic colleagues, a Dr. Herbst (who was also on the staff of the Empangeni Garden Clinic) and a Dr. Islam (a good friend of Dr. Ragoo who was on the staff of a sister institution in the nearby city of Richard’s Bay). Dr. Herbst was a wiry, athletic fellow and immediately asked whether I had got my crutches. “No,” I said. “The physiotherapist was reluctant to provide them to me before a doctor had explicitly authorized it.” Dr. Herbst immediately ordered another x-ray of the pelvis to clear the way for my getting a pair. The x-ray took place that afternoon, and by the following morning (Sunday, March 5), the physiotherapist, Lynne Beningfield, had outfitted me with a brand new pair of arm crutches. It didn’t take long to get the hang of them. I was soon out in the hallway taking walks to the nurses’ station and back.
The freedom brought by the crutches was intoxicating. With the enthusiasm of a babe that had discovered the ability to get up on two legs and walk, I fairly raced up and down the corridors.
Mercifully, I appeared to be healing. It was, Sister Jabu Mulango told me, a gift of the Lord. However this might be, I was elated at what I took to be progress. I could hardly wait until Dr. Ragoo’s return from Johannesburg on Monday morning. It was time to think about when we might return home.
VIII. Appreciating What Has Been Taken For Granted
As unwelcome as my accident was, it served at least one salutary purpose: to teach me to be grateful for the many things I have come to take for granted.
I am an active person, even athletic in many ways. I have become used to directing my body to do things and to having it respond effortlessly. This came to a sudden halt, of course, when I broke my pelvis. For days I was virtually immobile and for days after that needed the nurses and the draw sheet simply to turn from one side to another. Slowly, some of the missing mobility returned. When I was subsequently able to lift myself up on one elbow to receive some apple juice or a cup of hot tea, it was a breakthrough. What a wonderful thing, this ability partially to raise oneself in bed!
For a while after that, it seemed that I might not be able to walk again for a long time. Helped by the doctors and nurses, however, my body showed extraordinary recuperative powers. The Sister may have been correct – it could be that my healing was a gift of the Lord. Or it could simply be that the body’s capacity to mend itself is innate. Whatever its source, however, the ability to heal is still miraculous. For that ability we must be profoundly grateful. I think of it with every step I take. Although weeks later I still need crutches to put one foot in front of another, I am amazed that we human beings can walk at all. Little wonder that we take such joy in a baby’s first steps.
Of course, there are some among us who are truly gifted with athletic ability. The athletes whom I would soon get to watch perform in the annual NCAA Basketball Tournament, for example, are simply off the charts. Do they, does anyone, understand how truly magnificent their prowess and grace really are?
In context after context, we don’t truly appreciate something until we have deprived of it.
A variation on this theme is that we don’t understand how much we depend on other people, how much they provide the fabric of our existence and the matrix for our success, until we are cut off from them for a while.
In Susan’s and my case, the departure of our tour group friends had a two-fold effect. First, we were now physically separated from them. Having ready access to their companionship was an assumed part of our South African experience. Now they were gone. Second, their departure was a reminder of how truly isolated we were. All of our family and friends were half a world away. It was hard to imagine, sometimes, that we were still surrounded by their love and support.
How frequently we take that love and support for granted.
Of course, Susan and I were lucky. Through the Blackberry and the hospital telephone we were able to cross those miles. To a remarkable degree, we were able to maintain contact. As a result of modern technology, we could draw on that love of family and sustaining support of friends almost at will.
Now that we have returned to the United States, that love and support continues in the form of personal visits, as well as a continuing stream of cards, telephone calls, and emails. The people who are important in our lives have been there for us, and I am profoundly grateful.
Throughout the entire adventure, of course, Susan was the one person upon whom I depended continuously. Her love and support were a constant, from the time of my arrival in the Zulu village through the experience in Empangeni to this very day. How can I begin to express how much that has meant to me, how abidingly grateful I am for both the small things and the large that she did every day?
Whatever small successes I have enjoyed in my life to date have also taken on a new meaning. I am mindful today that individual success is only partly individually earned. Almost always, it has been enabled by the existence of a large – and largely unrecognized – network of relationships. I often flatter myself that I operate at a high and creative level. I seldom acknowledge, however, how many things have to be in place, how many systems have to be functioning, and how many people have to have been willing to do all of any number of antecedent things, before I can do anything. We are, of course, all dependent in this fashion. The Empnageni Garden Clinic, every modern hospital, every corporation and law firm, every family, every set of friends – indeed every society – is a large support system. Every achievement we claim for ourselves is in reality the product of many hands. Individuals may lead and may uniquely understand the potential of these systems. Individual initiative and determination are still critical to progress. But individuals should be slow to claim credit for their apparent achievements. Each of us stands on too many shoulders.
IX. Friendships and Partings
Dr. Ragoo returned from his trip to Johannesburg on Monday morning (March 6). It was good to see him again. Good, of course, from my standpoint as a patient. It was time for a discussion of when and how I could return home. But also good on a personal level. I had come to appreciate his intellect and his sense of humor and, to put it plainly, just enjoyed his company. Whether either of us realized it, he was now part of the ersatz set of friends that was evolving in Empangeni. We had a long, wide-ranging, and funny conversation as he meticulously took off the old dressing and created a new one.
The subject of my repatriation was among the subjects discussed. He had received some paperwork from AIG, the insurance carrier that underwrote the travel insurance package that we had purchased in connection with our trip. The question was when I would be “fit to fly” and under what conditions. The progress I had made over the last day in using crutches had helped. I might be ready as early as the coming Friday (March 10) he thought. My hopes soared.
Turning Dr. Ragoo’s projection into reality took some doing. We were unfamiliar with how the travel insurance coverage that was part of our trip package would actually work and also had no real idea as to how it would be coordinated with the international dimension of the Blue Cross/Blue Shield coverage that I had through my law firm. This all had to be sorted out, and appropriate claims somehow had to be made. Susan and Roger Ritch had gotten the ball rolling when I was first admitted to the hospital. Now another round of telephone calls to insurance company representatives and benefit administrators was required. Gradually, it emerged that AIG would take the lead. Through the worldwide, 24-hour, 7 day-a-week service that it maintained in Houston, Texas, AIG began work on the repatriation plan. There was an endless number of details to deal with. What was my precise condition? To what degree was I mobile and to what degree was I required to remain horizontal? Could I be moved in a wheelchair? (Yes, at least for short distances through the airports, as long as I was quickly restored to a supine position on the aircraft themselves and over long layovers.) Could I travel on commercial flights or would I need a dedicated form of transportation? (Commercial flights were okay, subject to the foregoing caveat.) It was a given that I would need to have a competent nurse or medic to travel with me, but would I need two of them? (No, as it turned out. One would be enough.) Would I need first-class seating? (Yes, in order to lay out in the supine position recommended by Dr. Ragoo.) Would my medical escort need to be with me at all times? (Yes, and therefore a first class seat would be required for him or her, too.) Would Susan fly with us? (Yes, of course, but in economy class, not in first class.) Could connecting flights be found with intervals between them great enough to permit an invalid to be pushed from where Flight A would land to where Flight B would board? (Yes, although it turned out that we would be cutting it closer than expected.) How would I actually board the aircraft given that at least two of the three would board passengers via stairs instead of via jetway? (I would soon learn what a Passenger Assistance Unit (PAU) was.) Would I at some point require the use of a trauma service helicopter? (No, thank goodness.) If not, what connecting ambulance services would be required? (Two as it turned out, one to take me from Empangeni to Durban for the first leg of the journey home, another to take me from Philadelphia International Airport to the Hospital of the University of Pennsylvania)?
While all of this was being addressed, I had to stay on my physical therapy regime and build up my strength. Dr. Ragoo had not declared me fit to fly, but had rather projected that I would be by Friday, March 10. It was my job to fulfill that projection. I worked overtime on my exercises, and with Susan’s help, walked the modest length and breadth of the hospital complex.
In our strolls together, I was again impressed with the way in which the clinic was run. It was spic and span and pleasantly decorated. The grounds, including all of the spaces between its several wings, were nicely landscaped. Labor is inexpensive in South Africa, and several people were continuously engaged in maintaining the outdoor plantings, edging the flower beds, and cutting the grass. The doctors’ offices on the premises were neat and had a professional appearance. (We visited the dental surgery department on my next-to-last day. Dr. Ragoo’s wife, Kashmira, was the staff dental surgeon. Her well-appointed office contained a brand new, state of the art, and highly expensive dental chair, with all of the incidents of a modern, cutting-edge dental surgical practice.)
The captain of the destroyer that I had served on when I was in the U. S. Navy back in the 1960’s would have approved. Everything in the hospital was ship-shape, and apparently being run with high efficiency.
On occasion we would “walk”, me on my crutches, operating under Susan’s watchful eye, out into the grounds. It was possible to sit out there on a bench under one of the many beautiful thorn trees. Here one could enjoy the African sun – filtered, mercifully, by the branches and lace-like leaves of the thorn trees overhead – and breathe some fresh air. These were very pleasant moments.
The well-maintained grounds of Empangeni Garden Clinic
Drs. Ragoo and Fourie each continued faithfully to visit me. There were inspections to be made of my progress, questions to be answered (Why was my left thigh partially numb? Because a nerve had to be stretched in the course of moving it to one side when the pins were implanted), and cautionary advice to be dispensed. But our encounters lasted rather longer than needed to address such medically important matters. Our conversations became longer and more personal. Ragoo was an Indian whose family had been in South Africa for five generations. He had traveled widely and had practiced before in Canada. A hospital in Alberta had recently recruited him and offered him a sizable salary increase. He and his wife had family obligations in South Africa, however. The money was fine for now. Besides he felt an ongoing obligation to Dr. Islam on the staff of the Richard’s Bay hospital. They had studied together and become close friends. Islam came to this part of the world only because his friend Ragoo had suggested it. The doctor was interested in my experiences as a lawyer. We compared notes on the nature of our obligations as professionals to our patients and our clients, respectively. He worried about the impact of the business of medicine, particularly the influence of the super-national pharmaceutical companies and the financed incentives they offer to induce physicians to use their products. In those circumstances, he wondered, did physicians always make the medical judgments that were best for their patients? Over the following days, there were more such conversations, rich, unhurried, wide-ranging, and thoughtful. We laughed a lot. Ragoo was becoming more than my attending physician. He was becoming a confidant and a friend.
Dr. Fourie was a more formal person but he was a striking conversationalist in his own right. Our talks always began with the medical business at hand, yet over the nearly two weeks that I was a patient at the Clinic, they, too, became far-reaching. His ancestors were French Huguenots, just as some of mine were. The original Louis Fourie – it may have been Fourier at the time – came to South Africa in the late 1680’s following the French King’s revocation of the Edict of Nantes. Protestants were no longer welcome in France. Some of the unwanted Huegenots, like my ancestors, came to the Americas. Some, like Fourie’s, came to the Cape Colony, what is now the metropolis of Cape Town. Unlike France, Huguenots were welcome here. Some had been vinters in France. Their wine-making skills enabled the Cape Colony to become an early center of the international wine industry, a position that South Africa still holds today. Dr. Fourie’s ancestor was probably just a laborer, he thought. He had tried to trace his roots back into France, but had been frustrated in his efforts. The French authorities of the day had not simply evicted the Huguenots but had also taken pains to obliterate any memory of them. In any event, Fourie was a confirmed South African with two children. He was formerly a general practitioner, and had done some forensic medicine once upon a time. Now he was certified in urology and active in that branch of the medical profession. I noted that a number of my friends in Philadelphia were urologists. He countered by bringing in copies of directories in which their names appeared. In short, as in the case of Dr. Ragoo, Dr. Fourie and I went well beyond the medical condition of his patient. We enjoyed the luxury of letting our conversations take on lives of their own, without boundaries.
A conversation with Dr. Fourie
Looking back, it is clear to me that Drs. Ragoo and Fourie did as much to rescue me from my occasional depressions in the hospital as they did to mend my body. I think that my company may in some way have been beneficial to them as well. I hoped then and continue to hope that our relationships might somehow endure. When Susan and I later invited each of them to visit us in the United States, we were most sincere.
Meanwhile, the traffic in email and telephone calls continued. In addition to communicating with family and friends and negotiating our passage home, I had a law practice to maintain. I was grateful to have so many competent and willing colleagues upon whom I could rely in order to keep things going. They were invaluable in allowing me to keep my recuperation front and center. But I must have a “Type A” personality. I needed to be assured that my clients’ needs were being met. Several clients needed to be informed of my situation – and reassured that they were in good hands with others. Through emails and telephone calls this was all accomplished, and I could return my attention to the business of getting well.
By Tuesday, March 7, Susan felt comfortable enough with my situation and her own personal safety to take a taxi tour of the Hluehluewe Game Preserve. Jacques and his wife picked her up before dawn and together the three of them went off to see the big game. I was grateful that this could be arranged. Seeing these magnificent animals was at least part of the reason we came to Africa. It would have been a real tragedy if she had been completely deprived of this experience on my account.
For me, the 7th of March was to feature another change of the dressing that covered the pins of the fixator. Dr. Ragoo performed this himself, wanting to pack the new dressing just right. He used a variety of sophisticated dressings, including one made of activated charcoal, and made sure that it would last until the day of our departure. He also changed my catheter. The new one, called a Foley catheter, was much more compact. It was strapped to my leg, permitting me to move much more freely. I might not yet be fit to fly, but I was getting there!
The middle of the week is a blur. My appetite improved, I slept better, and my legs were stronger. I could now turn in bed without assistance. In the meantime, the insurance and travel situations were clearing up. Dr. Ragoo faithfully responded to every inquiry made by the carrier and at last succeeded in laying to rest the notion that I might somehow need two medical escorts, not just one. In the meantime, Susan and I allayed the concerns of our family about the traveling that was to be done. Both Susan’s sister Nancy McKinney and our son Peter offered to fly to South Africa to keep Susan company and help me on the return journey. This would not be necessary, we assured them, while expressing our thanks for the offers. In the meantime, there was a mix-up in the dates of travel. Our Friday departure date had become a Saturday departure date. Then, quite abruptly, it reverted back to Friday. There it stayed, thank goodness. AIG retained a Mr. Shal (for “Shalom”) Sharp, a registered nurse and former South African Air Force medic from Johannesburg, to be my medical escort. He would meet the ambulance that was going to take me from Empangeni to Durban, then accompany Susan and me every step of the way from Durban to the Medical Center of the University of Pennsylvania (also known as “HUP”) in Philadelphia.
By late Thursday afternoon, everything was ready. One more dressing change in the morning and we were on our way.
Getting well enough to go home
Somewhere along the line, Pauline Pieterse, one of the hospital administrators who had befriended Susan, asked if I would write something for the hospital’s newsletter. I was pleased to and did. It came back edited and in a form I did not completely recognize. It was their newsletter, of course. I made a few revisions but did not make any substantial changes. A copy of the letter appears in an appendix to these memoirs.
March 10 would be another bittersweet day. We were glad to be on our way home, but sad to be leaving our new-found friends. We realized that, bereft of our existing network, we had participated in the creation of a new one in Empangeni. Now we were leaving it behind. Apparently these feelings were reciprocated. Pauline asked that we reserve some time for a meeting at the nurse’s station before our departure. We didn’t know what she might have in mind, but of course said that we would. We then turned to the multitude of things that had to be accomplished prior to discharge. There was a bill of some 76,000 rand to be paid. This was a modest amount by American standards, the equivalent of about $12,000. Fortunately, the hospital’s Credit Controller, a charming woman named Dilrupa Jagalal – “Rupa” to us – helped us to understand every nuance of the statement, and together we were able to get the insurance company to guarantee payment. There were medications to assemble, medications that I would need during the journey to the United States. There was a dressing that needed one last changing. Soon, all of these items were accomplished. Dr. Ragoo did a particularly elaborate job; whatever hassles lay ahead on the road or in the air, it appeared that I would get to Philadelphia with bandages intact.
As we completed our preparations, it seemed that an air of anticipation was growing. One by one, all of our Surgical Ward friends came in to say goodbye. It was hardly the usual checkout from a hospital. Hugs were exchanged and photographs taken. But this was only the prelude. Shortly after 1:30 p.m., Pauline appeared in my room. The ambulance had arrived, she said, but they would wait. We were now to report to the nurse’s station in the Surgical Ward. I took my crutches in hand, and together with Susan left my room and went down the hallway in the indicated direction.
What waited there for us was a complete surprise. Several dozen of the nursing staff had gathered, together with administrators, finance office personnel, and orderlies. The administrator of the hospital, Vanessa Fourie, was present. Ms. Fourie (no relation to Dr. Fourie) was an attractive and impressive lady. After introducing herself to us, she spoke to the gathering for a minute, wishing us farewell on behalf of the entire hospital community. Although I was emotionally overwhelmed, I managed something by way of a reply. Then I was told to sit down on a chair in the middle of the floor. As I did so, a troupe of signer-dancers came in from the courtyard. They were the hospital’s choral group and they were there to perform for us. Susan was close to tears. I pulled her over to me. The performers then arrayed themselves in a large semi-circle around us and began to sing, chant, and dance in a stunningly beautiful and rhythmic fashion. This went on for ten minutes, It was beautiful. It was unexpected. It was simply overwhelming.
An emotional send-off by singers from the Clinic
What had we done to deserve such a send-off? Apparently the hospital staff were as taken with us as we were with them. This extraordinary display was followed by hand shakes and more hugs.
Fortunately, for everyone, it was now truly time to leave. We thanked the musicians for their gift and said our final goodbyes to our friends on the staff. I then set myself down onto the stretcher. The two attendants wheeled me out to the ambulance, together with our luggage and my medical supplies. Moments later we drove away.
The long journey home had begun.
Horace Walpole coined the term “serendipity” in the 18th century. He had been reading an ancient Persian story called The Three Princes of Serendip. He noticed that “as their highnesses traveled, they were always making discoveries, by accidents and sagacity, of things which they were not in quest of.” It was a phenomenon that deserved a name, this making of incidental discoveries of things that one had not been looking for. The name would be “serendipity”.
The term keeps coming to mind as I survey the succession of things that Susan and I inadvertently “discovered” following my accident. Caring descendants of Zulu warriors. A remarkable health care facility in a small regional town in the most impoverished province in South Africa. A pair of doctors who were not only well trained medical professionals in their respective specialties but also highly interesting human beings. A nursing staff and hospital administration that embodied the multi-racial paradigm. New friends who looked after the emotional as well as medical needs of the two Americans who had suddenly arrived on their doorstep. An unprecedented farewell that touched us to the core.
And on a highly personal level, the discovery of the inner strength I needed to get through the adversity I faced, not to mention the concern for my welfare that was abidingly shown by both family and friends.
These were not things that I was looking for when we signed up to go to South Africa. Nor were they expected, even after the accident. They were simply discovered as we went along. Each was in some sense a gift, serendipitously found . . . and gratefully received.
XI. Repatriation To The United States
Our trip home had been arranged by AIG, the carrier that had underwritten our travel insurance policy, following a series of telephone conversations, faxes, and email messages between their Houston, Texas headquarters and Dr. Ragoo and ourselves. It involved an ambulance ride to Durban; flights from Durban to Johannesburg, Johannesburg to London, and London to Philadelphia, respectively; and an ambulance ride from Philadelphia’s International Airport to the Trauma Unit at the Hospital of the University of Pennsylvania.
The ambulance left Empangeni at 2 p.m. on Friday, March 10. After an uncomfortable, 150 kilometer ride on the N1 Highway, we reached Durban, the big city of KwaZuluNatal. A few more minutes and we were at the airport itself.
At the Durban Airport, we met my medical escort, the remarkable Shal Sharp. An RN and former medic, and a specialist in the art of medical repatriation, Shal appeared up to the task. He was engaging, medically knowledgeable, highly practical, and the master of numerous languages, including, importantly, English, Afrikaans, and Zulu, all three of which were to come in handy later. He made a point of having his stethoscope around his neck at all times. “It’s my passport,” he said of the practice. Perhaps most important of all, he had a knack for overcoming obstacles and getting things done.
Shal would be for us what Virgil was for the great poet Dante in his epic poem The Inferno. Virgil guided Dante through the nether regions of Hell. Shal would guide us through the 10,000-mile, often frustrating gauntlet of air travel – a little hell of its own – that we had to run in order to get from Durban to Philadelphia.
The first big hitch was the weather. As we waited in Durban for our flight to Johannesburg, we learned that Johannesburg was completely socked in by bad weather. This resulted in the delay of one flight after another. Friday afternoon was a bad time for this to happen since all of the many Johannesburg businessmen and women who had been doing business in Durban over the course of the week had booked every available seat. The airport was filled with unhappy travelers. For me this meant staying in a sitting position longer than had been anticipated and not being able to get horizontal as Dr. Ragoo had prescribed. There was of course no helping it.
The delays piled up, but fortunately none of the flights were actually cancelled. After an hour some began to get through. Our flight was called at last. We proceeded to the gate, an airline employee pushing my wheelchair, followed by Susan and Shal right on his heels, however, here we encountered a new obstacle: there was no jet-way. The flight was set up to be boarded by stairway, a stairway that I would not be able to use. Shal immediately came to the rescue: “We’ll need a PAU,” he said. He proceeded to get the attention of the right people and to negotiate the needed means of conveyance. After a short wait, a box-like unit pulled up to the gate. It was a Passenger Assistance Unit or “PAU”. This was a container on wheels with a telescope-like feature that would, on command, lift the container and its occupants high up into the air. By maneuvering the unit to one side of an aircraft – the side away from the side that normal passengers enter – then raising the upper portion of the unit to the height of the airplane’s door and extending a small ramp, the operator of the PAU could get a disabled passenger onto the plane. One enters the plane in the same fashion as the crates of ice or pre-packaged airline dinners were boarded a short while before! All three of us boarded the PAU. It then rolled away from the gate and proceeded to follow a slalom-like route through the maze of runways, finally stopping near the nose of the plane. Seconds later, I felt the hydraulics lifting us upward. When we reached the level of the plane’s right hand doorway, the PAU thrust out a small ramp until it fitted snugly against the plane. The doorway leading to the ramp then opened. That was my cue to leave the wheelchair and with the help of crutches cross over the ramp, with Susan and Shal right behind.
Entering an aircraft via a passenger assistance unit
We were now successfully on board the plane to Johannesburg. A hurdle successfully crossed, I said to myself. I gave Shal the thumbs up sign. I could relax now. We would soon be on our way.
Having been delayed in Durban, our plane arrived late in Johannesburg. Getting from the domestic side to the international side of the Johannesburg International Airport is a trek, as it is. Now there was very little time to make it. The ever-resourceful Shal found a wheelchair and an airline employee to push it, and we set off on a mad dash up ramps, into mini-elevators, across roadways, and down corridors. Shal’s command of Zulu came in handy, as did a few rand. We pulled up to the gate just as the flight to London was boarding. Another obstacle had been overcome! Ah, but there was again no jet-way. It appeared that some half-dozen other wheelchair-bound passengers and I would need a PAU, this time. South African Airways had its hands full that evening. The needed unit finally arrived, and all of us in wheelchairs were loaded on board. Again Susan and Shal got in the PAU, too, and we were in due course delivered to the waiting aircraft, a 747.
With a plane this big and this many wheelchairs and different seat assignments, the loading process was highly complicated. Nevertheless, we three and everyone else who had traveled in the PAU were finally loaded on board the plane.
Now we would be separated for awhile. Shal and I had seats in the first class area. (Poor Susan, traveling economy class, was remitted to a seat in the rear.) Here at last I could lie down in a comfortable bed-like first class seat. Shal gave me my meds and an anti-coagulation injection, and then I stretched out. I was at last able to assume the supine position that Dr. Ragoo had prescribed for my homeward travel.
The 11-hour flight was uneventful – the best kind. I ate a little, and settled into my bed. My goal was to sleep as much as possible. In the actual event, I got only two or three hours, but I was grateful for at least those few.
The transition in Heathrow was much easier. We had more time, and my wheelchair pusher was a spry “Lady Di.” “Diana’s my name,” she said, “but everyone calls me Lady Di.” In her late 60’s, she had decided to leave a boring retirement and to take the wheelchair pushing job instead of sitting at home. Her attitude was upbeat and her forearms impressive for someone approaching 70. We flew from one end of Heathrow to another in no time, and we soon were on board the British Airways flight to Philadelphia.
London to Philadelphia. The last air leg of our journey. I was both exhilarated and exhausted. Seven and one-half more hours and we would touch down on the familiar runway of Philadelphia International Airport.
I continued to be very uncomfortable, and sleep still would not come easily. My mind was full of the adventures that we had been through and the anticipation of being back home. Shal was a good companion, however, and we passed several hours talking. He had an interesting history, having become an RN, served in the Israeli Army in the 1967 war, gone into private business, been drafted into the South African Air Force (where he served for a number of years), and then gone into the medical repatriation business with his wife. He has done many such evacuations, occasionally from difficult African countries and at high personal risk. He has been arrested while on such missions and held for hours sans passport. Fortunately, he said, things have always worked out in the end. I had no doubt that the multi-lingual ability and respectful manner that I had observed in him have served him well in other, more difficult settings. As much as he is on the road, Shal is a family man. At virtually every opportunity, he called his wife. “How are you, my darling?” he would begin each call. He would always ask to speak to his son (who still lives at home with his parents). Shal was urbane, but could be emotional too. He became particularly emotional when talking about the prospects for his country. He hoped that things will go well and that the multi-racial experiment will succeed. He would like his children to stay and make their lives there. At the same time, he is giving them the best education he can so that they will be able to leave someday if they need to. Given the uncertainty of the country’s future, they need to be free, he felt, to choose their ultimate direction.
I must have dozed off at some point. We were now only two hours from Philadelphia. I had a very British breakfast (two soft-boiled eggs in the shell) and settled my thoughts. It was hard to believe that we were almost back in Philadelphia.
The plane touched down shortly after 2 p.m. on Saturday afternoon, Eastern Standard Time. It was wonderful to be back on American soil. After clearing customs, we found the ambulance crew that would take us to the Hospital of the University of Pennsylvania in West Philadelphia. Susan, Shal and I piled into the ambulance and headed up Pennsylvania Route 291 to the hospital.
I was admitted to HUP soon afterward, slightly more than 32 hours after our departure from the Empangeni Clinic. It was a grueling trip, but I was now in the hands of one of the premier medical institutions in America. I could rest at last. Our sons were on their way and would meet us shortly at the hospital. Our larger family and the friends of a lifetime were nearby. While more medical procedures loomed ahead, I was home.
XII. A Tale Of Two Hospitals
The University of Pennsylvania Medical Center is one of the great academic teaching hospitals in the world. Located in Philadelphia, one of the largest cities in the United States, Penn’s Medical Center is not only a major force in its own right but benefits by being surrounded by other medical centers and institutions of higher education in the City. Its medical staff are among the top of their profession and the hospital’s resources include some of the most advanced technology known to medical science. It sprawls across numerous city blocks in West Philadelphia, with cranes and new construction competing for space with the hospital’s older buildings. The result is something of a maze. It is a massive facility, employing a massive number of people. It faces many of the challenges that other large city hospitals do, and managing its multiple facets is a Herculean, almost impossible task. It can present an impersonal face to the world.
The Empangeni Garden Clinic is a modestly sized regional hospital in a small regional city in KwaZuluNatal Province, one of the economically poorer provinces of South Africa. It is not a Penn facility, but for its size it is remarkably sophisticated. The medical staff are well trained, and the nursing staff is large, well-disciplined, and remarkably responsive to the needs of hospital patients. The Clinic is attractively laid out, with pleasant grounds that are well landscaped. It has a very human scale, and is highly accessible.
Before I arrived in the ambulance at the emergency entrance of Penn’s Medical Center, I knew that I would be in good hands. Unlike the Empangeni Garden Clinic, Penn’s reputation had preceded it. I knew I was going to be well looked after medically. Indeed, this proved to be the case as a succession of doctors, including Dr. Pat Riley, Dr. John Esterhai, and Dr. Bruce Heppenstall, and a large number of residents and others in training, came by to check me out and consider what course of treatment I should follow going forward.
But a busy urban hospital like Penn’s Medical Center, notwithstanding all of its resources, would have difficulty competing with some dimensions of an Empangeni Garden Clinic. The cost of care in Empanageni is substantially less than the cost of care in the United States. Despite its lesser revenues, the Empangeni Garden Clinic somehow manages to be more welcoming. It can be more focused on the individual patient. Labor costs being lower, it can provide far more bedside care than a large, modern U.S. hospital can. And there is a degree of loving discipline in a smaller facility like the EGC that is hard to replicate in a large institution.
Of course, my experience in Empangeni may not be exactly typical. I was the rare American patient and was found to be interesting as a result. This factor would not exist in the case of the usual patient at the Clinic. Still, it is hard to imagine that the kind of chemistry that existed between the EGC staff and Susan and myself could occur at all in a large American hospital.
An institution like the University of Pennsylvania has still further advantages, of course. As the technology of health care becomes more and more sophisticated, Penn’s Medical Center is likely to have the latest and best that there is. Smaller institutions will find it difficult to compete with these advances, at least within the population of persons with wealth or good health care plans. Cutting edge procedures will be developed at academic medical institutions like this one, and those procedures will not be available elsewhere, at least for a while. Empangeni will not always be able to offer the very latest in such services. Nor will it be able to provide the breadth of training that a large institution like HUP can provide to the next generation of doctors.
We must thank God for the resources, both human and technological, that are available at places like Penn. But one wishes for other things as well. A human, patient-centric style of care-giving. Time for developing a personal rapport between caregiver and patient. An understanding by the patient of the challenges faced by the staff and, yes, an understanding by the staff of the psychology of the patient, the often scared and lonely patient. These qualities are often in short supply. We would do well to decode the secret of an Empangeni Garden Clinic, which had them in abundance, and put it to work in modern American medicine.
XIII. Final Reflections
I began this memoir with the questions that were on my mind when I first woke up somewhat bewildered in my library-become-hospital room. Why was I there? How did I get there? What were the forces that led me to that state? What caused it?
These questions of cause are essentially backward-looking, of course. In my case, there was an obvious answer – a horseback riding accident. But where did the chain of events begin? With the stumble of the horse? With my casual indifference at the beginning of the ride to the child-sized stirrup on the left side of the horse? With the decision to ride a horse down the steep trail to the Zulu village instead of taking the safer oxcart?
Or was there something still deeper at work? An unspoken sense of adventure? An ill-informed assessment of my riding prowess? A machismo that subconsciously directed me to choose the more dangerous course?
Was I in the grip of forces that inexorably, perhaps to an all-knowing observer even foreseeably, led to the accident that I had on February 25th. Was the accident inevitable? Had a clockwork universe simply wound down to the instant that the horse would fall and then to the succeeding instant when, given my poor preparation, my torso would hurtle forward onto the offending pommel of the saddle? Was it all predestined, or did I make bad choices? And even if I made bad choices, was I predestined to make them as a result of excessive excretions of testosterone? Was I even capable of making free choices? Indeed, are our choices only apparently freely willed, and really nothing more than the product of forces operating below our radar screens?
Did a supreme being come in here somewhere? Was there a God in heaven who arranged all of this, who had some sort of plan for me, a plan that was beyond my understanding?
Knowing that I was writing this memoir, a friend encouraged me by saying that perhaps my accident and its aftermath had occurred for a reason. She might have been suggesting that God had had a plan for me and that it included coming to the insights that I have reached and perhaps even included writing this memoir. This would be a wonderful thing, of course, although I’m too humble to think that he has very much time to focus on me with all of the other things he has to do, and at the same time too prideful to simply relinquish the controls to someone else.
And just how could God do it if he wanted to? Neils Bohr and the high priests of quantum mechanics have proclaimed that there is really no observable causality, at least at the subatomic level. Just a lot of unpredictable events, with particles moving erratically, occasionally appearing and disappearing into the quantum soup. Of course this may be just the mechanism God has seized upon. By intervening in these infinitesimally small events, perhaps he can somehow influence outcomes at the macro level without leaving any apparent fingerprints.
Philosopher-kings and scientists have wrestled and will continue to wrestle with these issues forever, I suppose. I don’t plan to join the fray. In the end, it seems to me that determining how we have gotten to any particular moment is not a productive exercise. What is more promising, I think, is to focus on the moment at hand, to take it as a given, and then to direct our energies toward fashioning the moments to come. What is past is past. The real question is what moments might I be capable of bringing to pass in the future? This is the great, creative challenge that humankind has before it.
A number of modern cosmologists have espoused the theory that we live in an ever-dividing set of parallel universes, with every possible outcome of every possible decision or event being represented in one of them. In one I have my accident. In another I don’t. And in each case, an infinite array of subsequent outcomes is played out, each with its own universe, and each of those leading to an infinitude of others. Each decision we make about our future – and each non-decision, for that matter – leads to a further branching of the multi-verse. Every outcome is represented in one or another of the branches. In that view of the world, our decisions, such as they are, don’t really count for very much. As consequential as a decision to do X might be to one branch, causing it to split off from all of the others, all of the other possible decisions – to do Y or Z or simply not to do anything at all – are simultaneously having their day.
I suppose that all of this is possible. After all, as Shakespeare would have observed, there are more things in this world than are dreamt of in my philosophy. (And so there may be an unending number of universes in which he never did write his plays and Christopher Marlowe wrote them, or Queen Elizabeth I wrote them, or he tried his hand at a few of them, gave it up as a bad show, and went into law school instead.) But I doubt it. I’m not a fan of the multiple universe hypothesis. I’m inclined to believe that we are going to trace only one path together. That path is going to be a blend of what we decide and do and what the other creatures of the planet decide and do and what natural phenomena come along in the meantime. It may be a good path and it may be a disastrous path, but it will be only one path and at the end of the road someone will be able to determine how we all came out. It is a universe of responsibility that I believe in, one that has consequences with which we and our children will have to live.
The stakes are high.
So what is my role? I am far from being all powerful. There are forces in the world that I live in that I can’t control and may not even be able to recognize. But I am a force in my own right. And I can maximize my small influence if I take a creative view of my moments and concentrate on how I can move the world in a positive direction. However I may have gotten to this moment, or the next one, or the one after that, the challenge for me is to find a way to think about the moment at hand as a beginning, as the basis, as a launching pad of moments to come, moments that I can influence, moments that will take place uniquely in time and that I am somehow responsible for.
Although I have reservations about anthropomorphic versions of the deity, I am deeply spiritual. Perhaps more than most, I am awestruck by the majesty of what I see about me. It is hard to avoid the conclusion that we are part of something much bigger and deeper than we can ever possibly know. There is an imminent sense of becoming about it, and an energy that we can tap into if we are open to it. If, unbeknownst to me, my actions are part of some greater plan, so be it. I have become part of something wonderful and transformative. I am not unhappy to be doing my part.
But I don’t see myself as powerless in the drama that is unfolding all around me. On the contrary, I sense that I am – I must be – an instrument of creation. I am only one such instrument, of course, but I am one. I believe that it is my responsibility to take the moments that are given to me – painful, joyful, and otherwise – and to weave them as best I can into something that I regard as beautiful. I need to be looking forward, to be focused on the possibilities ahead, to be part of advancing the experiment in consciousness that life is manifestly performing.
The moments that I spent in the wake of my accident were of course painful and trying. But in the end they were simply preludes. It was possible to overcome them, even to use them in a creative way, by thinking of them as precursors of something better. New moments were out there, ready to be discovered. This is, I think, true for everyone. All of us have the power to transcend the histories we have been given. By focusing on our new moments and not on those that have already passed, by imagining how we might mold the ones to come into something wonderful, by envisaging ourselves as part of an unfolding creative process that crucially depends on how we respond to our circumstances, we can make serendipitous discoveries, shape our futures, and create transformative experiences out of adversity. We can change for the better the one and only world we have been given. That, at least, was my experience in South Africa.
Brief description of the work:
In early 2006, John F. Smith, III, an American lawyer, civic leader, and frequent international traveler, broke his pelvis and sustained urological injuries in a horseback riding accident in a remote part of KwaZulu-Natal Province, South Africa. Although he suffered painful back spasms and internal bleeding, he was unable to get from the primitive location of his accident to a health care facility for over twenty-four hours. This memoir describes the journey that Smith and his wife made from the Zulu village where he was injured to a small but capable regional hospital in the town of Empangeni, his experience there, and his subsequent medical repatriation back to the United States. More importantly, it is an account of the remarkable people who helped them along the way and the insights that arose out of this shattering – but ultimately transformative – experience.