Something is wrong, something is upside down. The hunger striker and I stare at each other from opposite sides of a scaffold that neither of us constructed.
I follow the protocols, which are wise and worthy. But it is all wrong, everything is upside down.
My job is to work to improve or protect health. I have to find a way, to create a language that the patient and I will share; to locate and level the place where we will meet.
This contract is not spelled out nor ever inked; elsewhere there is no need. The patient is here, I am here, we can get down to work.
But when I attend the hunger striker all of this is inverted and twisted out of shape. The person whom I attend is not a patient: the person gives no sign, has no wish for my attention.
The non-patient never called me; I am a part of the system that he imposed upon first; now the system imposes me upon him.
The non-patient and I have opposite wishes: mine is to protect life and vital organs, his to destroy them.
The generality of patients whom I see here in the Detention Centre come to see me on my own territory; I mean the clinic. But the starver is weakened, usually lying in his room in the Compound which is located behind high, stout electrified fencing. The nurse and I walk along long corridors without natural light. Serial serious doors unlock to admit us and lock again behind us. We emerge into sunlight in an expansive open area, surrounded by discrete bedrooms for two persons.
I approach diffidently. Generally the fasting one receives me politely. I introduce myself, explaining that I am obliged to visit, and that – subject to my non-patient’s consent – I propose to carry out an examination and to provide advice.
“Have you drunk any fluid today?”
“Have you eaten?”
The nurse and I record responses. The interpreter and the guards report on any intelligence they’ve garnered. Sometimes a room-mate will report fluid taken on the sly. Perhaps some fruit has been consumed.
The nurse and I collect vital data: weight, temperature, pulse, blood pressure, respiratory rate.
I ask: “Do you think you can provide me with a urine specimen?” Remarkably, quite a few bestir themselves, take the offered jar, retreat and return, with the jar warm now, golden and embarrassing.
Urine is eloquent: it speaks with unmistakeable truthfulness and clarity about a person’s metabolic state. If the urine is ‘dense’, if there are ketones present, metabolism is compromised.
The nurse asks: “Do you mind if I measure your blood sugar?” Most comply, accepting without a blink the pricking of a finger pulp to draw blood.
A low sugar is a matter for concern. My manner is earnest and grave; I explain that soon or sooner, sugar levels will fall to the point where the starving person will lose consciousness. “At this stage, you are actually moving further from death than if you had remained conscious. So long as you are conscious, we must abide by your expressed wishes; we will not force fluids upon you.
Once you lose consciousness, we are forbidden to assume that you would refuse help to save your life. So we will save you. We will insert a needle into your vein and hydrate you.
You will not die.
You will not succeed in dying by continuing to starve yourself.
But well before you lose consciousness, you might damage yourself permanently – your muscles, your heart, your liver, your kidneys – all can be harmed.
You will live, but you may suffer from damaged organs for the rest of your life.
You will leave this place one day. Please do not create damage that will spoil your health for the rest of your life.”
My delivery of these warnings is measured, heartfelt. I want my non-patient to feel a tremor, to sense from the fear in my voice the proximity of harm.
Courteously, the starver nods: “I understand. Thank you doctor. But I will not eat, I will not drink. So long as I have no answer, I continue my fasting.”
The unnamed question whose ‘answer’ is awaited is, “Will I receive a visa?”
A soft dry hand is extended, it shakes mine weakly.
One man, older than the others, stands and looks at me squarely, hands on hips. He has greying hair and a bushy moustache bleached by tobacco smoke. “I did not ask for a doctor. I do not know why you have come.” His hard look hardens further: ”You speak very nice words, but you change nothing.”
The man’s language marks him as a member of a stateless people hounded across three nations. His face is a geography of grim knowing. No self-pity in his expression, no melodrama, no quarter, no concession in his obdurate resolve to live here as a free man or to die. He knows death; he looks it now in the face; death has visited his people long for as he can remember.
He pulls constantly on his cigarette, breathing out a cloud of smoke. He is thin, his facial muscles wasted, his moustache adding gravity to his speech as he dismisses my warnings. I watch his breathing and I listen to the rattle in his speech. His chest and his muscles show early signs of ruin. It is the ruin of belief, the ruin of his people.
I part from him as a child does who has threatened an adult and been laughed to scorn.
I am not slighted. Only the man’s wounds wound me.
Here is another starver. His blood sugar reading is 7.8; this, after five days of refusing food and drink.
Our little medical litany of non-survival runs in threes: “Three minutes without breathing, three days without water, three weeks without food.”
This person’s sugar level corresponds to what mine would be following a bacon and egg breakfast. And in a starving person, it is just as likely. This starver is lying; he is in truth, doubly a non-patient.
Of the twelve self-starvers whom I visit over the course of three weeks, four or five have sewn their lips together. Like anyone who reads newspapers, I had read of this practice with horror. I brought that dumb horror here with me.
When I actually come to see sewn lips, in the flesh, I am surprised by the elegance of the stitching. Fine grey thread, or navy blue, is looped just under the vermilion of the upper lip, connecting it to a reciprocal stitch in the skin of the lower lip. Some inmates favour a running suture, others create interrupted stitches. I wonder whether I, an experienced and trained suturer, would do as fine a job.
Invariably, a narrow aperture is left between the lips – sufficient for muffled speech, sufficient too for sips of water.
How does a detained person acquire this skill, I wonder? The nurse explains: “Inmates can choose to attend classes while in detention. Some learn English, others learn to sew.”
For the first time this afternoon a smile works its twisted way onto my own lips. In need of a long cry, my throat barks a short laugh.
The words of a dying man take on pith and moment, a significance not of this world. When that man who, seeking to die, speaks to me through his sealed lips, his speech vibrates with echoes of the biblical, of the prophetic. The voice I hear is the murmuring of Job.
Sooner or later the faster brings his fast to an end, the suturer frees his lips. On occasion, this has happened immediately following our visit, the faster asking for water or for an intravenous drip as soon as I have left the bedside.
One man whom I visit carries himself differently and speaks differently from other starvers. He is young, well formed, powerful in speech and in body. His peers recognize him as leader. They admire him for the daring and the execution of his escapades. His captors have segregated him here in this special compound, away from friends and potential disciples. His confinement is emphatically solitary and paradoxically unprivate.
The conduct of the guards is unremittingly proper and to their serious purpose. They complete page after page of detailed written observation. The confinement is conducted in a paradoxically thoughtful and polite environment. In this section, CCTV cameras record every moment, every movement.
I meet this fabled man in the course of my final day at work. He receives our visit with undemonstrative courtesy, listening respectfully to the quiet passion of my oratory. Finally he speaks, briefly and clearly. “This morning I drank black coffee, with no sugar and with no milk. In this place I will not drink again. I will eat no food in this place. I will fall here. I will starve. Or I will be returned to my friends.”
There is no bluster in this speech, no rhetorical flourish. No friends are present to witness his heroic resolution. The man is not even threatening us. He is supplying a polite and clear response to my remarks. This is a man who feels no need to impress. He is no-one’s inferior. He remains free in his thought and in his choices.
As I listen dumbly to his words, to his gravity, to his finality, I am as Crito to Socrates: I owe a cock to Asclepius; please pay it for me.
As we drive away, the nurse, a veteran of these encounters, says: “That man means it. Today is Day Four. His sugar level is low, he knows by now how starvation feels, he knows he can handle the sensations. He’ll see it through, I reckon.”
I have read of the sensations of prolonged fasting. After three days, the body weakens, sensations become distant, hunger and thoughts of food recede. Fasters report feeling lighter, almost euphoric as the levels of sugar fall and fall. Like a person lost in the snow, the starver sinks towards unconsciousness, experiencing paradoxical feelings of lightness or warmth.
I make my way out along the dark corridors, coming to an unexpected dead end. Above me is a steel mesh roof, on every side towers of heavy steel. Disoriented in the underworld, I have taken a wrong turning. I retrace my steps, locate another long corridor, this the correct one. A turnkey activates the release mechanism, I push the heavy steel door and leave.
While waiting for my homeward flight at the airport the next day, I see a dozen or more men, smiling hugely. These are fourteen inmates who have been granted visas. They will fly as free men on the same Virgin flight as mine. A cheering sight, all these mouths of smiling teeth.
Attending the men are their various case managers, young women. One says to her charge as he files towards the gate: “I am happy to see you go.” The man advances, puts his arms around her and holds her briefly. The woman’s eyes are red, her face collapses as the man pats her back deliberately, once, twice, three times, then turns and goes to his new life. The case manager buries her face in her hands. Her shoulders heave.
I am about to follow when I sight the guard who accompanied us yesterday on our visit to the resolute starver in solitary.
“How is your hunger striker going today?”
“Good as gold. Eating and drinking. He asked for food just a short time after youse left him.”