The Grinding Noise I Ignored Because My Patients Could Not Wait

Mrs Venter's Gate Code

Mrs Venter's gate code is the year she got married, 1961, and she told it to me on my very first visit as if she were handing me a house key. She was eighty-eight, she had a tumour the size of a plum in her pancreas, and she wanted to die at home in Waterkloof with her budgie on the windowsill and a view of the jacaranda she had planted as a bride. My job was to help her do that as gently as possible.

I have been a palliative care nurse for nineteen years. For the last eleven I have done home visits, which means my office is a white Toyota Corolla with a cooler box on the back seat, a sharps bin in the footwell, and a folder of patient notes that slides around the passenger side every time I take the corner onto Lynnwood Road too fast. On a normal week I drive between Mamelodi, Centurion, Silverton and the eastern suburbs, and on a bad week I drive at two in the morning because somebody's husband has phoned to say the breathing has changed.

The Car Was Never the Priority

I want to explain how it happens, because I think a lot of people who care for other people for a living will recognise it. Every single week there is someone who needs me more than my car does. When you are driving to a man who is frightened and in pain, the little orange light on the dashboard is not a crisis. It is a footnote. You say, after this week. Then you say, after this patient. Then you say, after December.

The car was a 2014 model with just over two hundred and eighty thousand kilometres on it. I had bought it second-hand from a colleague when she emigrated, and I had serviced it exactly twice in the four years I owned it. I knew this was not good. My brother, who fixes things for fun, told me so every Christmas. I told him I would sort it out in January, and in January there was always someone dying.

The Sound Started in Winter

The grinding started in July. It was faint at first, a dry scraping sound whenever I braked, like someone dragging a chair across a stone floor in another room. I turned the radio up. I told myself it was the cold. By August it was louder, and there was a judder through the pedal when I stopped at the robots on Atterbury, and I started braking earlier and more gently, the way you walk carefully on a sprained ankle instead of going to the doctor. Nurses are the worst patients. Everyone knows that.

Mrs Venter noticed before I did, in a way. She was sitting up in bed one afternoon in late August, very thin by then, and she said, "Sister, your car sounds like my late husband's Mercedes before it went through the garage wall." Then she laughed so hard she had to have oxygen. I laughed too. I did not do anything about it.

The Night on Solomon Mahlangu

The night it went wrong was a Tuesday in early September. A daughter phoned at quarter to one to say her father was agitated and pulling at his line, and could I come. They lived out past the Mamelodi side, and I drove along Solomon Mahlangu with my heart going and the grinding now so loud it drowned out the radio altogether. At the traffic light near the bridge I pressed the brake and the car simply did not slow down the way it should have. It slowed, eventually, but it went a good few metres past where I meant to stop, and I was sitting in the middle of an empty intersection at one in the morning with my hands shaking on the wheel.

Nobody was hurt. There was nobody else on the road. I sat there for a full minute and then drove on, very slowly, to my patient, and I settled him and held his daughter's hand while she cried in the kitchen. Then I drove home at twenty kilometres an hour with my hazards on, and I did not sleep.

Asking for Help Is My Job, Not Mine to Take

The next morning I sat at my kitchen table with a cup of rooibos and realised I had no idea where to even take the car. The man who had serviced it last had closed his place. My brother lives in Polokwane. I had a full day of visits and no car I trusted. I did what I tell my patients' families to do when they are overwhelmed, which is to stop, write one thing down, and do that one thing. I wrote the word brakes on the back of a pharmacy receipt.

Then I searched on my phone for a car service in Pretoria that was close enough to the east that I could get a lift to my first patient from there. I am not a car person. I did not know what to ask. I remember reading through a few websites and feeling the way my patients' families feel when they first read about morphine doses, that everyone was speaking a language I was supposed to already know.

What made me choose was small and practical. One of the places described itself as an RMI approved workshop in Pretoria, and I did not know what that meant, so I looked it up while my tea went cold. When I understood it was an industry body with standards and somewhere to complain if things went wrong, something in me relaxed. In my world we have the nursing council. I understood, suddenly, that I wanted the car equivalent of a registered professional, not a man with a spanner and an opinion.

The Man Who Showed Me the Disc

I dropped the car off at seven, apologising the whole time as if I had brought a neglected child to a clinic. The man who took the keys did not lecture me. He asked what I did for work, and when I told him, he nodded slowly and said, "So you drive at night." Later that afternoon he phoned and asked if I wanted to come and see the brakes before they did anything.

I went. He held up the front disc so I could see it. The pad had worn right down to the metal and the metal had been chewing into the disc, cutting deep shining grooves into it like the rings of a tree. "That is the sound you were hearing," he said. He was not dramatic about it. He said I had been lucky, and that most people wait exactly as long as I had, and that it was always the people who look after others who leave it the longest. I nearly cried in a workshop in front of a stranger, which I had not done even at the intersection.

They did the brakes and a full service and found a few other things that I will not pretend I fully understood. When I asked if it was all urgent, the same man told me plainly which items were today and which could wait three months. That honesty mattered more to me than the bill. I have had to tell families which things matter now and which do not, and I know how much trust it takes.

A Different Kind of Checklist

I collected the car that evening and drove to Mrs Venter's. When I braked at her gate, it was silent. Just the soft click of the indicator and the budgie chattering inside. She had her eyes closed when I went in, but she opened them and said, "Your car stopped complaining." I told her it had been to the doctor. She said, "Good. Now you know how we feel."

Mrs Venter died eleven days later, on a Sunday morning, with her daughter on one side of the bed and the budgie singing. I was there. Driving home afterwards, I noticed I was not bracing for the brakes any more, and that small absence of fear felt like something I had given myself.

What I Tell the New Nurses Now

I train younger nurses sometimes, the ones just starting home visits. I tell them about pain scales and family meetings and how to sit quietly in a room without needing to fill it. And now I also tell them, a little embarrassed, to find a mechanic in Pretoria before they need one, and to put the service date in the same diary as their patient visits. Not on a separate list. In the same diary, between Mr Nkosi's dressing change and the Bezuidenhout family meeting, because that is the only diary we ever actually read.

They laugh when I say it. I laughed too, once. Then I sat in an empty intersection at one in the morning listening to my own heartbeat, and I understood that you cannot carry anyone anywhere if the thing carrying you is falling apart.