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Cylindropuntia fulgida (Boxing Glove Cactus)

In my six years as a medical student in the mid-to late 80s, every single oral exam I participate in begins with the question, “Is jy familie van Stan Christodoulou?” In fact, it’s the first question I get asked almost any time I encounter a senior white Afrikaans male at Stellenbosch University’s Faculty of Medicine. This, even many years after I graduate and return to the faculty to take up an academic post in the mid-2000s.

Stanley Christodoulou is one of the world’s greatest boxing judges and referees. The first man to have refereed world title fights in all 17 boxing weight divisions and the first South African to be inducted into the International Boxing Hall of Fame. He has officiated at almost 250 world title bouts and been awarded the State President’s award by both FW de Klerk and Nelson Mandela for his contribution to grassroots boxing in South Africa. In short, the man is an icon in the boxing world.

Reproduced with permission from African Ring

I am not related to Stan but after the 2nd or 3rd time someone asks, I no longer admit that. Instead, I craft a long-winded response – in Afrikaans - that is guaranteed to eat into the first few minutes of my allotted exam time. It centres around the fact that Stan Christodoulou’s parents were also Cypriot immigrants, that his mother was born in the same region of Cyprus as my own parents, and that my uncle Andreas has met him a couple of times and is convinced a distant family connection exists. I deliver all of this in Afrikaans to ensure that I don't offend any professor who may be biased towards English-speaking students. There are more than a few of those.

It does strike me as somewhat ironic that my mostly nationalist or conservative, right-wing, male professors are so quick to acknowledge a Greek man’s contribution to South African sport. A Greek man whose claim to fame is that he can skilfully mediate between warring parties who negotiate with their fists. A man whose efforts paved the way for social integration in the South African boxing world many years before interracial fights were allowed or Apartheid dismantled. I’m never certain if being related to him will elevate my status or diminish it in my professor’s eyes. Perhaps they’re simply hoping I can get them tickets to a boxing match? Either way, I relate to the need to be a skilful mediator.

I was born on the 7th of September 1966. The day after Dimitri Tsafendas (also a Greek man) assassinated the architect of Apartheid, Prime Minister Hendrik Verwoerd. I am not related to Tsafendas either, but I can certainly relate to his inclination to stab the man four times.

My junior school years in an all-white, parallel medium government school in Port Elizabeth were littered with prejudice and discrimination. “Bloody Greek, stupid Greek, dirty Greek, hairy Greek, greasy Greek, go back to Greece where you belong, Greek”. A tiresome litany of abuse that was constantly directed at me, my siblings and my cousins by our fellow classmates, most of whom were the children of low-income government employees who worked for the local railway services or middle-upper class Afrikaans academics employed by the nearby University of Port Elizabeth.

Initially, I felt confused. Then, hurt. Eventually, I became resigned. I tried ignoring the perpetrators as my parents suggested. I tried reminding them that the Greeks had founded Western civilisation as we know it and that the Olympic games had originated in Greece – more advice from my well-meaning parents that only yielded further insult. As I got older, I tried pointing out that Cyprus was not part of Greece and that my people had been colonised by the British for many years too. Perhaps a common enemy might make a difference? It did not.

I thought a lot about the idea that I should go back where I belonged. Where was that, exactly? Not South Africa, country of my birth, where my dark Mediterranean features and “foreign culture” designated me a “Griek”. Not Cyprus, land of my ancestors, where my fluidity with the English language and middle-class South African lifestyle - a stark contrast to the rural life my grandparents lived - designated me an “Africana”. The essence of me – a sensitive, relational being - slowly disappeared in the lonely spaces in between.

Books became my refuge and intellect my defence. I was small – always the smallest child in my class – but my brain was not. It gave me a competitive advantage that, in time, silenced anyone who might dare to call me stupid or inferior. My brothers discovered that fists sometimes spoke louder than words and that excelling academically and on the rugby field was a guaranteed formula for commanding respect. They did both.

I remember the day my mother arrived to fetch us from school and found my younger brother in the midst of a brawl with two boys who had been calling us derogatory names yet again. The image of her dragging those boys by their ears along the school driveway and barging into the principal’s office to demand that he do something definitive about this ongoing and unacceptable situation - while my cousins and I huddled together at the school gate - is still very vivid in my mind. It was the first and perhaps the only time I witnessed an adult in my family get enraged and fight back.

Today I recognise that obsequious deference is a survival strategy; an effort to tend and befriend the enemy in order to stay safe. It was a strategy that I too internalised and adopted well into my adult years and at great cost to my own wellbeing. The options to fight, flee or freeze in stressful situations were known to me, but the tendency to fawn is one I only learnt about much later. It’s taken years of therapy to undo that conditioning and, in all honesty, it’s only recently that I feel able to stand up for myself in an embodied and centred way. Being able to write about some of those early experiences is part of the journey and so are boxing lessons. Perhaps I am related to Stan after all!

Looking back on all these things now, it seems incredibly ironic that my professors chose to ask about my Greek name in their misguided attempts to put me at ease in a stressful exam situation. I know there’s no way they could have known about my experiences as a child, but did they realise that their question about Stan centred their own interests and experiences rather than mine? Did they know that Verwoerd’s government had come close to classifying Cypriots as Asian rather than European? Would I have gained entry into their esteemed medical school if they had? What might my distinguished professors have asked me then, I wonder?

Dr Maria Christodoulou

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Content warning: Graphic description of a medical gynaecological procedure (D&C).

Image: Bibbie Friman

It’s around 2 am and I’m standing in an operating theatre in the bowels of Tygerberg Hospital preparing myself mentally to do a dilatation and curettage. Also known as a D&C or in layman’s terms - a womb scrape. It will be the second time I do this procedure. The first time I do it alone. My supervising registrar is at home sleeping and has “every confidence” that I can do the procedure without him. He’s an advocate of the surgical teaching method, “See one. Do one. Teach one.” No one has asked if I’m an advocate too.

I’m 24 years old. A recently qualified medical intern in my second week of a six-month rotation in the Department of Obstetrics and Gynaecology. At this particular moment, I’m dressed in surgical scrubs and a green surgical gown, neither of which were designed for my petite frame. The length of the gown drags along the floor making it difficult for me to walk without risk of tripping and the belt has been wrapped around my waist twice in an attempt to gather all the folds. Clearly, I don’t conform to the surgical mould.

My dark hair is hidden beneath a blue disposable surgical cap and my facial expressions are obscured behind a surgical mask. I’m not sure that I positioned it correctly because it’s pinching my nose, but I can’t do anything about it now. I stand with my hands held up in front of me, palms facing towards me so that I don’t touch anything with my sterile gloves, and I wait for the anaesthetist to indicate that I can begin.

My patient, a young woman and mother of two came into the ward earlier this evening with heavy vaginal bleeding. She claimed not to know that she was pregnant but the evidence on examining her was unequivocal. She’s had an incomplete miscarriage, which is why she’s bleeding so heavily and why we both find ourselves in an operating theatre at this ungodly hour.

The words scrape, scrape, scrape reverberate in my head. I read a novel a few years ago that began that way: scrape, scrape, scrape. In that story, a teenager was having an abortion. Is that what’s happening here? It’s 1991 and abortion is illegal in South Africa. Is that what I’m about to facilitate? I can’t be sure but my gut instinct tells me there’s more to this woman’s story than she let on. It’s safer for both of us if I don’t know.

She lies in front of me now, her unconscious body draped in green sheets. Her legs bent at the knees and spread-eagled in lithotomy stirrups to make it easier for me to access her womb. Her face is obscured from my view by the green curtain that separates the anaesthetist from the surgical field. The only evidence of human life amidst the sea of green is the discreetly exposed vulva that stares at me from between the sheets. Shaved, catheterised and stained with betadine solution. It strikes me as quite vulnerable and undignified - being a woman at the mercy of the medical system.

The anaesthetist finally confirms that the patient is ready. She may be ready but I’m not sure that I am. I take a deep breath, say a silent prayer and step forward. I tell myself that this is a necessary procedure to save her life now – perhaps in more ways than one.

I begin by inserting a speculum so that I can visualize her cervix. I go on to dilate the cervix with a series of rods, each one slightly larger in diameter than the one that came before. I'm not sure that it's entirely necessary because I can see that her cervix is dilated, but I follow procedure just in case. Then, I insert what looks like a spoon-shaped vegetable peeler into her uterus and begin to scrape. Scrape, scrape, scrape. Scrape away all traces of her pregnancy and the bleeding will stop. It’s simple enough. A routine procedure. Except tonight it doesn’t seem to be working. My patient doesn't stop bleeding.

I keep scraping. I try not to look at the contents of her womb as they fall into the kidney dish in front of me. I feel beads of sweat forming on my brow. My heart beating erratically. My brain racing with an invisible stream of panicked thoughts. On the outside, my demeanour remains calm and collected. On the inside, it’s a different story. The anaesthetist tells me to speed it up as my patient’s blood pressure is dropping from the ongoing loss of blood. I don’t know what to speed up.

The nursing staff look at each other over their surgical masks with a look I’ve come to know well in my time as a medical student. It’s a look that indicates that my performance is inadequate, but that they know it’s not their place to tell me. It’s also a look that suggests they know something I don’t, but they will withhold this information in the subtle powerplay that goes on between us. I’m the doctor and they are nurses. My authority and superior knowledge unquestionable, right? Right. That’s how the hierarchy works. Things go wrong when we forget our place in the hierarchy.

Which is partly why I find myself in this situation right now. I may be a doctor, but the truth is I don’t have the necessary experience. Right now, I have no idea why my patient won’t stop bleeding or what to do about it. I breathe deeply. Scramble for a coherent thought. Breathe deeply again. Try to think it through logically. I have scraped as extensively as I believe I can without causing damage to her womb. I don’t know what else to do and everyone in the room knows it.

A pregnant woman receives an abortifacient draught from a peasant "wise woman"; she falls ill but the physician cannot save her life; her funeral is attended by her family and neighbours. Colour lithograph by S. I︠a︡guzhinskiĭ, 1925. Wellcome Collection. In copyright

Finally, the anaesthetist looks at me from behind the green curtain and suggests I get my registrar on the phone. Of course. That’s what I’m supposed to do. That’s how the hierarchy works. I step out of the theatre and get the staff nurse to dial the operator and ask them to page him. He calls back an interminably long few minutes later and the nurse holds the phone to my ear so we can talk. I stare at the blood on my gloves while I listen. Blood on your hands, says a voice in my head. I ignore it and go back inside.

I do as the registrar suggested and instruct the anaesthetist to give her intravenous drugs that will constrict her blood vessels, and I scrape some more. I scrape until I am absolutely certain that there is nothing more to scrape. I scrape until even I can feel that I am scraping tissue that shouldn’t be scraped. It works. She finally stops bleeding.

I do many D&Cs after that one but she always stays with me. I don't remember her face or her name, but I do remember how it felt to scrape her womb. For a long time after, I lie in bed at night wondering whether it was a miscarriage or an abortion gone wrong (right?). Wondering if she ever fell pregnant again or if I scraped so much of her womb away that I took that choice away from her. I don’t really want to know. It’s safer that way.

Dr Maria Christodoulou

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Content warning: Graphic description of human anatomy dissection by medical students.

“Before you can hear, much less follow, the voice of your soul, you have to win back your body. You have to go on a pilgrimage beneath the skin.”

~ Meggan Watterson, Reveal ~

Lamprocapnos Spectabilis, "Bleeding Heart"

I’m 19 years old. It’s January 1986. The beginning of my second year at Stellenbosch University’s Faculty of Medicine. I’m in the anatomy dissection hall on the fourth floor of the Fisan building for the very first time. My colleagues and I have been assigned to the second table from the end. Christodoulou, Conradie, Conradie, and Conradie. I’m the odd one out - again.

Almost 40 years later, I still remember everything as if it were yesterday. It was the day I met Gertrude. The beginning of my very first pilgrimage beneath the skin.

Rows of stainless-steel tables and harsh fluorescent lights. Vinyl tiles on the floor. Green chalkboards with cherry-coloured wood frames on the walls. Trays of sharp instruments. Black, council issue refuse bins at the end of each table, and a group of fidgety medical students dressed in new and heavily starched white coats. I have a red dress on underneath mine. My roommate, Karen, and I took photographs to mark the occasion.

Professor Malan introduces himself and talks about respect. Reminds us that we are ethically obliged to behave like professionals. Invites us to bow our heads as a Dutch Reformed priest leads us in a prayer to honour the contribution of those we’re about to meet. The smell of formalin and anticipation is in the air.

Finally, the time comes to take out our textbooks and begin. We unwrap the plastic bag and expose her. Our cadaver. A woman. Brown skinned, wrinkled, lifeless and embalmed. I’m afraid to touch her. She looks like she has lived a hard life. Her hair is curly, coarse and sparse. It’s also grey. Even her pubic hair is grey. I haven’t ever thought about greying pubic hair before. Her breasts are shrivelled. Her belly scarred. We name her Gertrude. It seems only fitting she should have a name if we’re going to be intimate.

Johan and I appropriate her right side. Petra and Suzanne her left. We’ll meet in the middle and share discoveries along the way. Johan asks if he can make the first cut and I’m amazed (and appalled) at his eagerness to start. Am I the only one that’s freaked out by this? The only one that doesn’t really want to do it? Everyone around me looks so confident that I don’t dare ask.

The dissection of a young, beautiful woman directed by J. Ch. G. Lucae (1814-1885) in order to determine the ideal female proportions. Chalk drawing by J. H. Hasselhorst, 1864.

Instead, I watch calmly as Johan slices down the middle of Gertrude’s breastbone with a steady hand. It looks easier than I thought it would and there isn’t any blood, which, in some weird way, I find comforting. Eventually, I feel an unspoken pressure to prove that I have what it takes, so I take a turn. I’m surprised at the sharpness of the blade and how smoothly it slices through her skin. Skin that feels like leather that’s been left out in the sun too long. Tough, dry, brittle. We dissect it loose from the layer of soft, yellow, oily fat that lies beneath it. My stomach turns.

Her muscle fibres look like the frayed edges of dried biltong that’s been torn into strips. We lift a section of them off her ribs and create a flap. An opening. The sound of her bones breaking is sharp and crisp. Her ribcage unlocks and her heart is exposed. I’m surprised at how small it is. No bigger than my fist and compressed between her left lung and a hugely swollen liver. A liver that has overwhelmed her chest cavity and cornered her right lung. I imagine her alone, homeless, with a cigarette dangling from her lips and a bottle of alcohol in her hand.

We remove and inspect her organs one by one. We saw through her skull with an electric blade that sounds like a dentist’s drill and sends bone dust flying into the atmosphere. We slice her brain into segments. We trace and follow her major arteries and veins, and dissect and separate her muscle fibres to their origins and insertions. It takes time this dissection of humanity. An entire year in our case. There’s a lot of human waste in our quest for medical knowledge.

Eventually, it gets easier. We settle into a routine: supervised dissection two afternoons a week and many informal hours at Gertrude’s side in between, especially close to tests and exams. I read the instructions and look over Johan’s shoulder as he dissects - an arrangement that suits us both. We eat lunch with Gertrude, laugh by her side, discuss everyday concerns, behave as though all this is normal, which I guess it is for medical students. I try not to think about what we’re actually doing, but the smell of death embalmed clings to everything – my clothes, my hair, my skin – and follows me everywhere. It’s how everyone on campus identifies me as a second-year medical student. A symbol of my lowly status in the medical hierarchy.

As we systematically reduce Gertrude to a collection of separate body parts, I find myself less interested in her anatomy than I am curious about her story. I want to know who she is. Who she was. What her life was like. How she ended up on a dissection table. There are clues, of course. Her blackened lungs, her swollen liver, her emaciated body. The scars of pregnancy and childbirth. The fact that her brown body was donated to science in an apartheid South Africa. That in itself a story that needs to be told.

As I look back on my years at medical school today, there are many rites and rituals that stand out in my memory. The story of Gertrude is the one most symbolic of my experience of medical education as a whole.

I was - and often still am - the odd one out. An outlier in my way of thinking and being, and a cultural misfit. The process of learning was disembodied, frustrating and depressing. It focused on inanimate organs and body parts rather than human beings. It was about disease instead of health. It reinforced and perpetuated the social injustices of the political context in which it was being taught.

I didn’t realise it back then, but Gertrude not only opened a door for me to learn the anatomy of the human body. She also confronted me with the inescapable reality of the emotional, social and spiritual suffering inflicted on her by the world we both lived in. A world whose impact was indelibly etched onto her body and beginning to seep into mine.

Intuitively, I knew that what I was learning at medical school didn’t even begin to scratch the surface of what was needed for healing to occur. My time with Gertrude, however, planted a seed. A seed that would germinate and sprout many years later and take me on another pilgrimage beneath the skin. A pilgrimage to win back my own body and express the voice of my own soul. A pilgrimage that is unfolding even as I write.

Dr Maria Christodoulou

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