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I remember a valuable lesson I was taught during my internal medicine rotation during a Friday night call. Unlike surgery, when one can vaguely predict the onset of a tsunami of patients like pay day, end of the month and public holidays, internal medicine was completely the opposite. Constant in its large influx of patients despite the hour, day or year.

I found myself quite lucky to be only called to casualty for 8 patients that day and my admitting roster looked rather bland, just the way i liked it. I purposefully plonked my behind on one of those uncomfortable benches in casualty and observed the chaos unfold.

Wet gangrene, bowel obstruction, burns to the neck, abcesses and the wards ringing my surgical colleague non stop. What a marvelous show. I felt the venomous stares the surgical intern was darting my way whilst I sipped my liquifruit in peace.

The peace didnt last a moment longer when my phone began to buzz. I said a silent prayer hoping it would be outsurance or another company trying to scam me of my juice. Of course it was not. I regretted enjoying my colleagues suffering, as i knew my own was soon to come.

“Moosa 1 sick patient heading your way” and click. Hung up. Wow, i thought, blown away by the detail. And sure enough, I was about to meet the woman who taught me a life lesson I’ll never forget. She was a middle aged Indian lady who smelled faintly of perfume. She wore a bright red lipstick but her eyes looked fatigued and ridden with sadness. The reason lay next to her.

I scanned the gentleman who lay infront of me. Couldn’t have been a day older than 16 so i assumed he was her son. Covered by a Mickey mouse blanket. I read the admitting notes and I shrugged. “20 year old male, Parasuicide, ingested painkillers (unknown amount) and jik, 6th attempt , using whoonga and heroine, collateral from the mother”.

6th attempt. That bothered me and I couldnt hide it. An emotion surfaced within me which I wasn’t all too familiar with. It boiled from the inner crevices of my bone marrow and erupted at the lips of my mouth. “Why have you done this to yourself , please tell me why!”

The lady looked at her son with blatant shame mixed with pity. “Doctor, he is a troubled boy. I dont know how to help him” help him? Help him!?

I wondered why this bothered me so much, after all freedom of choice is the standard. His choice belongs to him, and him alone. But what about those who have their freedom of choice snatched away? My mind was buzzing with anger. My speech stagnated by my rage.

I thought of the 4 year old I saw the week before who was knocked by a car and died due to a head injury. Or the gentleman who was stabbed on his way to work and bled out until he died with just me, a stranger, at his bedside. I thought of the 38 year old hippie i met with lung cancer, who died on his way to CT scan. Or the 40 year old lady with breast cancer who left 3 children behind.

Where was their choice?

I walked away to compose myself. The heat of the air was rising and my chest tightened. Does this boy know the cost of a life? I thought of the countless of hours i spent resuscitating patients, the hours in surgery spent putting people back together, the effort time and resources. Does he know?

My entire life was based on saving lives and here he is, trying to end his. The feeling of plain uselessness lingered. I trotted along and did my duties. Admitted him, IV line, bloods drawn. All along there stood his mother, observing, comforting, enabling.

As I was about to leave, his mother followed me out. “Doctor I dont know what more I can do for him. Ive lost my entire life trying to save him. But i realised, i am no match for him and his addictions.”

I said curtly “with all due respect, i don’t think he wants to be saved. He is self destructing”. She gripped my hand tightly.

“You don’t understand. That is exactly why he needs saving. This is not my son. This is a shell of a man embalmed by his bad choices. I’ve lost my house due to his theft and drug buying, my husband left us after he stole our belongings and sold it for R5 on the street. I’ve been to rehab with him 8 times , making sure he stays. Ive been beaten with fists by his druglord friends for trying to drag him home. Ive kicked him out of the house , tried to show him tough love. I’ve lost my job. My life. My son”

The rage in me dissolved. I felt the familiar pain that ached. I didnt know what to say.

“You will only understand when you have a child. The love you are bound by, a curse and a gift. The ability to eternally endure all for the sake of your child. Uninhibited. Unconditional.”

She patted her eyes dry and positioned herself next to her son. Bowed her head between her palms

And prayed.