I woke up on a fine Thursday morning, feeling the usual wave of exhaustion hit me straight in the appendix. I had been having a nightmare of a week, attending to between 100 to 130 patients a day from Monday to Wednesday. 300 odd people and the week was only mid way. Exhaustion was the only name of my game.

My eyes battled to open, my lips stuck firmly together and my bones ached a familiar ache, Burn out. I felt quite disappointed in my body, deciding to give up on me now!? Granted, I had been doing the 100-patient-a-day thing for the past 8 months.

You see, i joined a rural clinic at the start of the year and i instantly fell in love. The primary setting spoke to me. I loved seeing the weird and wonderful cases that walked through my door. I loved polishing up on my isizulu and interacting with the locals. And mostly, I loved the people i worked with. I began to learn so much and my confidence tripled.

However, as Murphy would have it , we soon found ourselves in a dire predicament, classic of a south African bed time story. A gang began targeting doctors, nurses and pharmacists and a hijacking syndicate ensued. 3 doctors resigned immediately, prioritizing their safety above all. 3 of us remained, foolish but determined.

The first day was unbearable. The crowds were vast and the que was never ending. The daily work which was delicately distributed on 6 hands was now dumped on 3, and we clearly could not manage. Patients were waiting around 6 to 8 hours just to be seen by a doctor, frustrated, angry, hungry and sick. A terrible combination from the get go.

Emergencies were attended to immediately which then extended the waiting time of the non – urgent que which ofcourse, made everyone frustrated. The pressure of being in multiple places at once was mounting. One would be stabilising a patient while another was seizing in the background. Stabilize one and the next would crash. Refer one and 6 would be wheeled in.

My baseline heart rate was racing to 110. My mind would race from the moment I arrived at work to well until after i had left. I would be stuck between pushing a que and providing quality care to every patient I’d see. That became the status quo.

This thursday, I had mustered all my strength and dug deep for my energy reserves because of course, I was on call. I prayed for an uneventful day and night so my mind and reserves could recuperate.

I got none.

A patient with a head injury met me at 7: 45am sharp so i did the needful and transferred him to our district hospital. I consoled myself and got on with the day. Nightfall approached and the call progressed.

He was flopped over in a wheelchair wearing a blue hoody over his bald head. He was thin and faded, and looked quite sick.

His eyes shone like the sun, soaked in bilirubin, jaundice. I was worried.

His frail frame shuffled uncomfortably as his disproportionate abdomen distended before my eyes. The spidery veins engorged.

I did a quick examination and concluded he had a portal hypertension. He needed to be transferred to a hospital. This was nothing new. I wrote the referral letter and dialed the number while i waited for a response, I closed my eyes to sneak in a second of sleep.

I woke to the sound of clicks and slaps.

2 young buff policemen were within my gaze. One handcuffed the patient to the bed while the other slapped his back.

I stood up alarmed.

“What the hell are you guys doing to him? He is sick, cant you see?” I said.

They looked at me casually.

“Yeah he is sick. He is in possession of a gun which belonged to a policeman who was brutally murdered. He also runs a drug syndicate and a brothel. He is sick”

I was stunned.

Before I Could organise my thoughts, they had escourted him out to retrieve the gun he had apparently hidden in a nearby bush.

“Please Don’t find that gun, please do not come back with that gun and please do not shoot us..” That’s all that ran through my tired mind.

I waited at the gate until I heard the screeching vehicle return. They offloaded the patient and announced they had not found the gun but gained some useful information. I was relieved but also disturbed. Where Could the gun be?

They exhanged some information while I waited for them to return my patient.

I looked at him so frail, ill and timid. Is this man capable of murder? Is he running a drug syndicate and brothel? He seemed so lifeless and weak. It was hard to imagine him harming anyone. But what did i know?

I escorted him back to casualty while we waited for the ambulance.

An awkward silence plagued the room.

“Did you kill that policeman?” I asked him.

His gaze wandered. “No.i bought it from someone else”

I sighed. “Where is the gun? If you care about what is left of your life you need to give the police the info they need to get off your back so you can focus on getting better. I’ll transfer you to the hospital where they can help you and you can recover”

He nodded and the exhaustion in his eyes mimicked mine. I could tell he was tired of running. Tired of hustling. Tired of trying. His body was giving up on him. His mind not far off.

He stood up and excused himself to use the bathroom.

I waited patiently for his return so i could insert the IV line and get him prepped for the hospital. I closed my eyes and sneaked in a few minutes of needed sleep.

I woke 10 minutes later to the sight of a the greyish silver barrel in front of me. I feared it was pointing me square in the forehead.

I stood up and stepped back.

There it was, the missing gun. I called for the man who returned it but there was no one in site.

I called for the patients name again, hoping he was not far off. No one came.

I stared at the gun for a while. Wondering what would become of him. Whether he had murdered the police officer. Why his life had become what it was.

I called the police station to report the gun and I walked away.

3 days later I was called to the emergency room to certify a man who was a DOA (dead on arrival). I saw the blue hoody, the frail body, the distended abdomen…

And i knew.