Single Minded

By Marina Auer

When Murphy Meyer arrives at Eden State Hospital on the first of January 2001, driven to solve a small, personal mystery, the young doctor has no idea she’s deposited herself into something larger and darker than she could ever have imagined; something that has a life of its own.
Few at Eden State Hospital can claim to be single minded where duplicity is standard operating procedure. 

• Language: English
• Publisher: Kwela
• Release date: Jul 19, 2024
• ISBN: 9780795710131

Marina Auer

Marina Auer is a graduate of UCT Medical School and spent several years working in state hospitals, before moving into private practice. She lives with her family – two teenagers, two cats, one husband – in Hillcrest, KZN. Double Edged is her first novel. 

Book preview

To be clear, it was a wheeled chair, not a wheelchair. Knocked together in a simple workshop somewhere in the neighbouring township, the chair had a paint-flecked frame, rubber-tipped handles and four small wheels. While previously in possession of an unpadded pine seat and back, it now lacked even those basic comforts. Four flat metal bars remained where wood had once been attached. The chair offered uncompromising discomfort.

The doctor took care to swaddle blankets around the patient’s torso, and positioned a soft pillow to support the patient’s head.

Together they made the journey along deserted corridors, through dimly lit passages. The doctor was silent, except to grumble the few times the chair’s wheels remembered they’d belonged to a shopping trolley and took a direction contrary to the one intended.

Away from the main building, they wove down a corrugated-iron tunnel, past the laboratory, towards an annexe. Built as a late addition to the hospital, the two outlying wards were reserved for acute psychiatric cases and medical isolation.

The patient was bound for neither.

Beyond wards G and H, a barren path of compacted ground snaked past an almost buried basement entrance. A river of debris emerged from this portal, overflowing with the detritus of hospital life. Here, the chair’s broken cohorts lay.

The chair did not stop but trundled along as path became road, dirt became tar, then dirt again. It continued down a hill and around a corner to a steep bank. The bank defined a boundary between where the maintenance department assumed responsibility and where it declined to do so.

The grass on top of the bank was shorn short; below it was not. Below the bank the grass was long enough to obscure a short man standing. Or a tall man lying.

The doctor pushed the chair to the very edge of the incline, unbound the swaddling cloths and, with a heave and a grunt, expelled the patient into the air.

The tall grass opened its many arms and welcomed the falling body into a final embrace.

PART 1

abandon all hope ye who enter here

Chapter 1

1 January 2001

Murphy navigated her Mazda 323 down a road paved with potholes, indicated to turn, then jerked the steering wheel back as a minibus taxi swept through the intersection without bothering to pause.

‘Fu— idiot!’ she gasped and thrust down on the hatchback’s hooter.

The anaemic baaap made no difference to the taxi, which had disappeared into the dusty distance, oblivious to any other cars, pedestrians, goats or cows on the township road. The driver’s sole focus was to commute his commuters as quickly as possible as many times as possible in order to meet his daily quota. The passengers paid up front, so if they perished before they reached their destination, it was no skin off the driver’s hunched back.

After checking for any other oncoming traffic, pedestrians, goats and cows, Murphy resumed her turn into Eden State Hospital, Level Two Healthcare, KwaZulu-Natal Department of Health, visiting hours 15:00–16:00.

A sign hung crookedly on the perimeter fence, pockmarked by bullet holes through one corner, warning that firearms were not permitted past this point. Next to it a glossy new placard stated that the hospital was baby-friendly and supported exclusive breastfeeding (with no mention of the mother-to-child HIV transmission risk that incurred). A faded ANC election poster completed the triptych. Thabo Mbeki’s face, features paled by exposure to two years of sunlight, smiled smugly from the canvas.

A fine beading of sweat blossomed on Murphy’s forehead and her clammy hands slid on the steering wheel when the security guard emerged from his hut, opened the gate and waved her through into the grounds. The road curved away in an inverted question mark, the hospital a dark point at the summit.

‘Indawo yokupaka lapho.’ The tall man used his assault rifle like an airport marshal’s baton to point up the hill. Murphy followed his directive. She had no other option.

A hand-painted placard lodged in an overgrown patch of grass confirmed this was indeed the way to the parking area. The ground soon became even more pitted than the main road. At least the effort to steer her wheels clear of holes kept Murphy’s attention off the swirling butterflies in her stomach. Last night’s solitary celebration – Thai takeaway and a single glass of champagne – was threatening to make a rapid transit through her digestive system. She took a gulp of water from the bottle on the passenger seat. The tepid liquid slid down her throat like castor oil.

Four other vehicles squatted in the parking lot: two mud-spattered bakkies, a white Suzuki Jimny and a battered Subaru with a Gauteng Province registration. The owners evidently familiar with the pitfalls of this place, all the cars had higher clearance than her small hatchback, and no doubt boasted off-road capabilities that outclassed it.

Murphy waited for a lean black cat to lead its litter of kittens across the gravel before easing the Mazda into a bay. She turned off the engine and wilted. Her dipped head sent a riot of red frizz spilling forwards and damp ringlets clutched at her cheeks. The day already shimmered with thirty-degree heat and ninety-two per cent humidity.

Murphy rested her forehead on the steering wheel. She remained glued there while the engine cooled and the interior sweltered. Sleep had become an escape from the bad dream of her life over the past six months, but last night she’d woken every half hour from 03:00 onwards in anticipation of the 05:30 alarm.

The sound of tyres on grit shot her upright. She swiped dry the dollop of sleep drool that threatened to spill from one side of her mouth and turned to see a muddy Toyota double cab pulling into the adjacent bay. The driver gazed directly at her through his sunglasses. His mouth twitched with a smile. Or a smirk.

Fully awake now, Murphy pulled a hairband off her wrist and used it to regain some semblance of control – if only over her hair. By the time she’d gathered her bundle of belongings from the passenger seat (water, food, scrubs, stethoscope and a paperback in case it was a quiet call), the other driver had vanished, and her opportunity to follow and find the staff entrance with him. She sighed, peeled her sticky limbs from the stifling vehicle and closed the door with a soft shove. Murphy left nothing in the car. The passenger door never locked properly. The radio was long gone.

On foot, she circumnavigated the gravelled lot. While the front of the hospital was a brown-bricked, blank-faced, seventies architectural monstrosity, the back end was a mishmash of prefab walls, breeze-blocks and corrugated iron. If Victor Frankenstein had pieced together buildings instead of body parts this would have been the result. Scaffolding crisscrossed the entire west wing, rising all the way up to a derelict fourth floor.

Murphy weighed her options: wander around the maze looking for a way in, or boldly go where no employee ever went (if they knew any better) and brave the main entrance.

Decision made, after ten metres of high-stepping through the long grass her scalp prickled with the sensation of being observed.

Murphy’s gaze crept up and up until finally coming to rest on a cat perched on a fourth-floor ledge. Next to it, a tattered curtain lifted and twisted in the lazy breeze. While she watched, a second cat crept out through a broken window. Crouching down, bum raised, it prepared to pounce. Murphy stepped back, bracing for the imminent attack. Wiggle, wiggle and—

A rifle butt hit her between the shoulder blades, shoving her forwards. ‘Tsssk!’

‘What—?’ she gasped, grabbing for the scaffolding and shrinking away from her accoster.

Not a guard; a patient. Not a rifle; a crutch.

The man tsked again, and leant heavily on his wooden crutches, winded by the effort of stopping her.

‘Aayi, dokotela …’ A threadbare gown couldn’t hide the torture-like device attached to his leg. A metal cage of rods and screws that penetrated skin, drilling into bone to force broken edges together. ‘You are failing, dokotela,’ he wheezed.

‘What? I only—’ I’ve only just arrived, she wanted to protest. Give me a chance, at least.

‘Bheka.’ He used the tip of one crutch to part the grass where she’d been about to step. A single strand of chevron tape had draped itself down the side of a crater. A coffin-deep excavation where a rusted yellow pipe lay half-visible in oil-slicked water scummed with dead leaves and scraps of litter. ‘The hole, dokotela. You are failing in.’

As she edged forwards to inspect her near miss, nose crinkling at the foul waft of decay, a small ripple broke the surface. A desperate paw clawed at metal.

‘Oh no!’ Murphy cried. ‘Is that …? There’s a kitten in the water!’

‘Tcha.’ But he too leant down, peering closer to see the scrap of fur that scrabbled, exhausted, against the pipe.

‘Can I …?’ She indicated the man’s crutch. With a shrug he ceded the pole. On her haunches, Murphy approached the edge of the hole.

‘Come, kitty,’ she said, offering the strut as a bridge. ‘Come on,’ she coaxed. With a burst of life the creature wriggled and kicked. It leapt onto the crutch and scrambled towards her. Murphy shrieked and shot backwards, dropping the prop in the grass.

‘I thought … I thought it was a cat,’ she said.

The patient was laughing so hard he had to stagger to the scaffolding for support. ‘Udokotela wekati, udokotela wamagundane!’ he roared.

Murphy handed back his crutch, and he swung away, still shaking his head and chuckling at her foolishness.

Chapter 2

After taking a long minute to steady herself, Murphy nestled her stethoscope around her neck and set off again – to the main entrance, this time.

With only a brief hesitation, she selected the wheelchair ramp. A couple of limp bodies lay sprawled over the well-worn steps. The men could have been sleeping off their New Year’s Eve hangovers, or were dead. It was that kind of hospital.

At the top of the ramp, a double wooden door splayed wide in welcome. Over the threshold, a pool of blood congealed on faded green linoleum, lethargic ceiling fans casting shadow and light across its sticky surface. Pulsatile, the spillage seemed to devour the gathering flies rather than the opposite. A hungry, undead mass.

Murphy shook her head, ridding herself of the illusion. Dodging the splatter, she headed for the lifts, pressed the button and waited.

‘Not a good idea,’ a voice said.

Whirling around, she came face to face with the double cab driver. Close on two metres of tanned, toned man; blue eyes and tousled brown hair, straight out of a Camel ad. He gave her a blatant appraisal. Although Murphy should have been used to people’s stares – beginning at her wild hair and ending with her weird eyes – the experience was always disconcerting. Medical people, with their board-sanctioned curiosity, were usually the worst offenders.

‘That lift,’ Camel Man said. ‘Not a good idea to use it. Packed up twice in the last week.’

Without waiting for a response, he headed for the stairwell. Murphy blew out her cheeks and followed.

She had to brush past a patient, propped against the wall and puffing. He held a cigarette in one hand and a crepe-bandage loop in the other. The sling was a makeshift handle for an underwater chest drain. One end of rubber tubing snaked beneath his grubby hospital gown, the other bubbled in the water-filled glass bottle that acted as a one-way valve to drain a pneumothorax, air trapped on the wrong side of the lung. Murphy eyeballed the precious cigarette that stuttered towards the man’s lips. Would that dose of nicotine be doubly potent with only half of his pulmonary capacity functional? Lucky guy.

Camel Man didn’t give the smoker a second glance. ‘Which floor are you going to?’ he asked.

‘Uh, theatre? Second floor?’ The end of each sentence rose in pitch.

Stop it, Murphy told herself. You know it’s the second floor.

‘Second floor for theatre,’ Camel Man confirmed. He was dressed in faded jeans and a collared blue shirt that by accident or design exactly matched his eyes. Fortunately, he led the way and did not turn around to interrupt her inspection. ‘First day?’

‘Uh, sorry. What?’

‘Is it your first day here?’ He enunciated every word over his shoulder.

‘Uh, yes?’ She tried again: ‘Yes, first day.’

They reached a scuffed wooden door.

‘Here we are, second floor,’ Camel Man announced like a train conductor. ‘Theatre, ICU and general surgical wards.’

Murphy had to squeeze past his imposing form. He smelt amazing: a mix of aftershave and African sunshine that was all male. She stopped herself from drawing in a second, deeper breath, and blushed for the third time.

The hint of a smile lifted the corner of his mouth. ‘Good luck.’

‘Thank you,’ Murphy remembered to say when the door had already swung shut behind her.

The theatre complex was situated to the left of the stairs and the lifts, making it a direct route for the porters to transfer patients to surgery from the other floors. Three gurneys had been abandoned outside large swing doors that announced Theatre. Authorised personnel only beyond this point. And, more simply in isiZulu, Akungenwa.

The gurneys were rudimentary means of transport. With tops of cold steel, their only concession to comfort was a thin layer of industrial-strength paper towel. While the wheels were sturdy, the legs wore peeling paint. Patients would be lifted onto these litters at admission, then shifted across to padded plinths in the trauma unit. Covered with drying blood and other body fluids, the gurneys’ presence here, outside theatre, suggested that the patients had had to bypass casualty and be brought up to surgery stat.

The previous night had been just another New Year’s Eve filled with celebration and savagery in Mzansi.

Following a trail of bloody footprints, Murphy gave the swing doors a shove and stepped into the theatre complex. The doors swooshed shut behind her – the rush of air a firm hand at her back, ushering her decisively onwards.

Changerooms branched off on both sides of the passage. On the right Males/Doctors; on the left Females/Nurses. She qualified for both.

Murphy entered the doorway to the left, and almost backed right out. Discarded scrubs littered the floor. A red-bagged surgical waste bin overflowed with disposable theatre caps and shoes and plastic aprons. Treating the debris like a game of hopscotch, she skipped to a small clear space next to the bench, her own clean scrubs tucked under one arm. She took off her street clothes, pulled on the dark-green pyjama-like attire and secured a sunflower-spangled buff over her head and wild ponytail. There were no clean theatre shoes in the dispenser; her Nikes were going to have to just do it.

Murphy hunted around for an empty locker. Then she hunted around for an empty locker without a broken door. She’d just stashed her belongings in one that fit her criteria, and secured the lock, when her Nokia began to warble from inside the cubby.

She fumbled with the combination padlock, rifled through her clothes’ pockets and grabbed for the phone.

‘Hi, Mom … Mother? Diana?’ She squinted at the small screen. There was only one … none … then again one bar of reception. Her mother’s voice blared from the device. Murphy jerked. The cellphone slipped from her hand, hit the ground, bounced and landed on one of the few clothing-free patches of linoleum. Not a scratch on it, but the call had dropped.

Murphy sent a message to her mother, punching in the letters with her thumb. A quick 2-2, single 2, single 3 spelled out Bad. Typing the rest of the message took longer. Bad reception. Will call tmrw.

She hit the delete button and typed tomorrow instead.

The changeroom’s other door opened directly into a theatre tearoom. The shabby space smelt of microwave meals and mouldy carpet. Half-emptied coffee cups and crumpled food wrappers bore witness to a night of hurried refuelling.

A body lay sprawled on the couch, snoring deeply. One pale, almost hairless arm was thrown over the sleeper’s eyes, denying access to the harsh reality of 1 January. A badge dangling on a lanyard around the man’s neck identified him as Dr Richard White. Murphy’s memory bank identified him as one of the post-call medical officers she was there to relieve.

In a reasonable world, a new job would not start on a public holiday. The world of medicine was far from reasonable, however; state hospitals particularly so. New contracts, especially those of interns and community service officers, kicked off on the first day of the year and ran through to the last pop of (other people’s) champagne corks on 31 December. Public holidays were like any other day – twenty-four hours when either you were on call or you weren’t.

So it was that Murphy found herself working at Eden State Hospital on the first day of 2001, the Year of the Snake. She was taking over from a crew who had been up the whole night trying to keep alive the gunshot abdomens, stab-chests and polytrauma generated by that lethal combination of excessive alcohol and deficient policing in a poverty-riddled area. KwaZulu-Natal – second most populous, third poorest, highest murder-rated of South Africa’s newly minted nine provinces.

The door on the opposite side of the room swung open, its handle gouging another fleck of plaster from a well-scarred spot on the wall.

‘Dr White,’ a nurse called. The exhausted doctor did not budge. ‘Dr White!’ The nurse hurried forwards.

‘I’m here to take over,’ Murphy interposed before the man’s sleep could be disturbed. ‘Dr Meyer.’

The nurse gave her a whole-body scan that would have rivalled a state-of-the-art MRI and did nothing to boost Murphy’s confidence.

‘Dr Claymore needs help in Theatre 3,’ she said. ‘Gunshot neck.’

Murphy felt her own throat close up. She gulped against panic and followed the nurse’s rapid footsteps out of the tearoom.

OT 3 was well lit and warm – uncomfortably warm for a surgical environment. A rush of heat suffused her armpits. It was 07:12 and Murphy’s antiperspirant had already done a full day’s work.

Chapter 3

Khetiwe Makwetu forced herself to meet every eye as she walked into the antenatal clinic. These were her people. Well, perhaps not quite her people. But they were the ones she was at Eden State Hospital to help. Because as hopeless as the situation was, unlike so many of the staff here, she would not turn a blind eye to their suffering. Or a deaf ear. Or a mute tongue. Although sometimes they did not like to hear what she had to say.

‘Emergencies only, today,’ Kheti said, facing the row of pregnant women waiting on the hard wooden benches.

They mumbled to each other in isiZulu.

‘It is a public holiday,’ Kheti explained. ‘And our team of on-call staff here is small. Not the usual full contingent.’ The usual useless contingent. ‘So if your issue can wait for tomorrow, or even better next week, perhaps come back then.’ No one budged. ‘Or stay, and I will see you when I see you. But if I have to go to labour ward …’ she spread her hands in apology, ‘you will have to wait.’ A nurse handed her a pile of files. ‘Have you triaged them, Nurse—?’

‘Minnie,’ the tiny woman responded. ‘I am sorry, doctor. I am new here. I was not sure.’

‘Never mind,’ Kheti replied. ‘Bring in the first patient.’

They slipped behind a cubicle partitioned off just with curtaining. Confidentiality was a luxury Eden State could not afford.

Nostrils flaring, the patient facing Kheti breathed in and out with short, laboured puffs. The work of building her baby and fighting the virus raging through her body was destroying her. Her upper arms were skinny enough for Kheti to encircle with her thumb and forefinger.

‘Baby is growing well. You are doing a good job,’ Kheti reassured the mother.

For what it was worth, she prescribed multivitamins and a course of antibiotics. What the woman really needed was antiretrovirals. But she was not going to get them here.

Minnie led the dying woman through the curtains. Kheti followed them out.

‘Tell her that she has to try to stay strong,’ Kheti attempted a last offering, even though she could already sense the woman slipping away. ‘Tell her that after the baby is born her body will recover.’ The lie in her words was audible to all; the others waiting averted their gaze. ‘The baby will need a mother. Who will look after a child who is also ill?’ Kheti tried to reason with them. But there was no reasoning to be done. What was asked of this woman was too much. What was asked of all of them was too much.

The patient shuffled off with her useless script. A male cleaner came wheeling a mop bucket down the passage, making the women peel their feet from his path. Kheti pressed the heels of her hands to her temples.

‘Kunjani, dokotela?’ Minnie asked. ‘Are you okay?’

‘I know what kunjani means,’ Kheti snapped. She addressed the cleaner: ‘Can you stop that awful noise?’ The bucket wobbled to a sloshing stop; the high-pitched whistling continued, though, then mercifully faded beyond a wall.

With the abrupt return of her hearing, Kheti’s other senses could focus on what was before her. ‘What is that smell?’ she asked, peering into the bucket.

The mop’s strands floated in water the colour of an eclamptic’s urine. Coca-Cola. The reek, however, was sour. Overripe. Organic.

‘What do you have there?’ She pointed at a red rubbish bag. Used for soiled medical waste, it was supposed to go into a designated bin in the basement, not get conveyed through her clinic like a trophy.

The hospital’s incinerator was no longer functional. While the tower remained, the furnaces lay cold and silent. The locals, normally complacent about what the winds of fate blew their way, had drawn the line at the sooty debris that drifted over their homes and washing lines with the prevailing southwester. They knew where the ash came from and could imagine what it was comprised of. Baba Simeon’s cancerous bowel, Ugwayi Walter’s amputated leg. Ma Nomsa’s fourth placenta. Now, large white vans came every week to collect the sealed red bags from the depths of the hospital and ship them off to be someone else’s problem.

Despite Kheti’s obvious aversion, the cleaner grinned and lifted up the bag. Its contents jerked.

‘Merde!’ Kheti yelped. ‘What is that?’

‘Igundane!’ he said with glee.

‘A rat,’ Nurse Minnie translated. ‘The guards were shooting at it, in the hospital entrance.’

‘They were shooting at a rat? They were shooting at a rat?’

Minnie nodded in confirmation.

‘You had better watch out for the guards then, Minnie.’

The nurse blinked at her.

‘Minnie – a mouse?’

But Kheti’s attempt at humour had been lost in translation.

Chapter 4

Like a mob of meerkats, the staff in the operating room all swivelled their heads as the new doctor walked in. Murphy’s attempt to meet the expectant gazes with a confident smile faltered.

In what would have been a position of leisure on a beach, the patient lay in a posture of alarm on the narrow theatre bed. Incapable of lying flat, he had propped himself up on his elbows and, with his entire being, concentrated on breathing. Each inhalation was laboured and loud, a harsh whistle that should spark a warning in the heart of any medical person hearing it: a sign that the patient’s airway was in dire peril.

A young female doctor stood at the head of the bed, a pair of syringes in hand. Her momentary relief when Murphy and the nursing sister walked in was replaced by uncertainty. Dr Claymore had expected Dr White to come to her rescue; instead a stranger stood in the doorway, her pale forehead beaded with sweat.

‘New doctor here,’ the nurse pointed out unnecessarily.

The junior MO nodded a tense greeting.

Murphy took in the scene. The Boyle’s machine – old, but one she’d used before. The monitors showed a tachycardia, but a stable blood pressure. The patient was maintaining an oxygen saturation of 90% on room air