Ayanda: A story from Infectious Futures

Written by A.S. Fields

In 2015, we commissioned six stories about a future facing up to the challenge of antibiotic resistance called Infectious Futures: Stories of the post-antibiotic apocalypse as part of a much larger effort to publicise, educate, and enrich the conversation around the subject. These stories, originally in print form, will be uploaded as blogs, one at a time into an online collection. Enjoy!

Ayanda

IT WASN’T so much pain as a veld fire that would not go out. A never-ending slow burn. An attack. An onslaught. Like the mountains across the peninsula, which blackened at every change of season, Ayanda simmered in the heat of it.

It wasn’t a new pain. Ayanda remembered, vaguely, an incident after a particularly energetic tryst at a music festival in the Karoo. That had been many years ago and all she could remember of the braided young man was his smile. The only late nights in her life now were at the agency. No music. Just deadlines.

She dispatched Anton to buy Citro-Soda at the chemist’s, a concoction she had always believed her mother had used for indigestion. The internet insisted it would bring her relief.

It brought none.

Ayanda spent the night broiling in bed, getting up every half-hour to visit the bathroom. Anton sat up with her. “Go to the doctor tomorrow. We should still have an account at the clinic. Promise me?”

She promised.

Citro-Soda – sodium bicarbonate urinary alkaliser used to alleviate the symptoms of urinary tract infection

“There’s blood and leukocytes in your urine,” explained Doctor Pienaar as he read her results. “So it’s definitely a UTI. Have you been having unprotected sex lately?”

Ayanda blushed. “Not recently, a week, maybe two weeks ago. I am married,” she added, to make it clear that she wasn’t one of those girls who went around having unprotected sex for fun.

Dr Pienaar gave a quick twitch of the eyebrows and looked back at his notes. “I’m prescribing an antibiotic called Utin. Take one after meals for two days and that should clear it up.”

“Thank you,” she said, stuffing the script into her handbag. She already felt a little better after seeing the doctor. Mind over matter.

Utin–400 – norfloxacin broad-spectrum antibiotic with antibacterial agent. Indicated for the treatment of upper and lower urinary tract infections including cystitis

A week later the heat was back. A flash fire. Ayanda returned to the clinic before it consumed her.

Dr Pienaar was not overly concerned. “Recurrences are not uncommon. The bugs are becoming more and more resistant to antibiotics. Have you had a UTI in the last few months?”

She shook her head. “Only once before. When I was younger.”

He nodded. “I’ll put you on a stronger course of antibiotics and we’ll have your sample sent away to be cultured to see what we’re dealing with. In the meantime I suggest you and your boyfriend…”

“Husband.”

“… husband, wear a condom. And when you use the toilet, try wiping towards the back to prevent the bacteria entering your system.”

Ayanda blinked at the indignity of the conversation. She was not a child that needed to be told how to use the bathroom. She left without asking for a letter booking her off work. She didn’t mention her return visit to her husband, but took the antibiotic, a giant white capsule, which contained penicillin (a large orange sticker on the box informed her of this) and felt better within an hour.

Ayanda and Anton didn’t celebrate their anniversary in their usual fashion and decided to go to bed early. She showered first, because her colleague Skye, a self-professed expert on feminine hygiene, assured her that bathing was a sure way to spread germs around. “You’re practically soaking in your own filth,” she said.

Augmentin – amoxicillin/clavulanic acid penicillin-based antibiotic used for fighting bacterial infection in the body

Ayanda was working late on an outdoor banner advertising the thirtieth birthday of a car dealership when she felt a cloudy sensation near her navel. She excused herself and went to the bathroom. Instead of relief, she felt the same virulent pain as before. She stopped at the chemist’s on the way home for cranberry tablets. The all-knowing Skye had explained that there was something in the berries that stopped bacteria from sticking to the urethral walls.

Cranberry herbal supplement used as a preventative for urinary tract infections 

Life became a system of prevention. Hands were washed before going to the bathroom. Both parties showered before intimacy; to save time, this often took place in the shower. Ayanda even laid down tissue on the toilet seat in the office bathroom. It was so easy to believe that someone else’s negligence was the incendiary, like an inconsiderate smoker throwing a stompie out of a car window and causing devastating mountain fires. If only she could educate them on hygiene. Perhaps she and Skye could team up. They were ad people after all. They could convince anyone of anything.

Despite her efforts for a germ-free existence, Ayanda returned to the doctor’s office nearly every two months when the veld fires raged anew.

She would never see Dr Pienaar again. Instead, she regularly emptied her wallet for a private gynaecologist who had her office in one of the greener suburbs.

“You’re doing everything right,” said Doctor Goolam with her usual exuberance, “although I’m surprised the cranberry tablets aren’t working. I’m going to prescribe a urinary antiseptic that you can take every day.”

“Macrodantin?” asked Ayanda proudly. She had done some internet research on the subject.

“No. Not Macrodantin. That’s been out of stock for months. I’ll prescribe something else. What it’s going to do is clear the bladder and make sure nothing stays behind.”

“And do I take this with the antibiotic?” Ayanda asked.

“Until you finish the course. I think we’ll stick to Augmentin this time, really make sure we obliterate that infection. There’s no point prescribing any of those others anymore. This bug is clearly resistant.”

“And the culture we sent away?”

“I’ll get my receptionist to send you the results when the lab gets back to us, but I suspect this is a nasty little sucker. Don’t worry. You’re in the right hands.”

After a few months Dr Goolam had deflated. “Well I tried to fix you. And I don’t like losing, I’ll tell you that. I suggest you see a urologist, my dear. I have the name of a fantastic doctor I refer all my patients to.”

Puromylon – nalidixic acid antiseptic used in the treatment of chronic urinary tract infections

Dr Miller reminded Ayanda of the Hollywood plastic surgeons on DSTV, all white teeth and expensive open-collared shirts.

The urologist made a small circle with his thumb and finger. “You’re emptying your bladder fine. So what I think we’re dealing with here is a narrow urethra. In some people the walls are very narrow, so instead of passing through with the urine stream the germs stay behind.”

Ayanda didn’t think she would ever get used to her bodily functions being spoken of so casually. She adjusted her shawl and listened.

“I suggest a small procedure – completely safe, of course – where I dilate the urethra. There’ll be some bleeding but you won’t have any problems after that, I promise. I’m ninety-percent sure.”

Ayanda swallowed dryly. “Surgery?”

He beamed her a West Coast smile. “Next week good for you? I’ll have my receptionist set it up.”

Urethral dilation a common procedure to correct urethral stricture; the surgical widening of the urethra

“Hospital?” asked Anton. “But what’s wrong with you?”

Ayanda tried to explain how the narrowness of her urethra was causing all her agony. He scratched his head.

“Well, if it’s going to make you better. Listen, I have to run. I’m assisting on a shoot tonight.” His camera bag was lying next to the door.

“Again? Are you going to be very late?”

“Depends,” he said, shouldering the bag. “A shoot ends when it ends.”

Ayanda nodded and watched her husband slip away into the night for the second time that week.

“You’ll feel some pain when you go to the toilet. But this should pass with time. We had to use a catheter so there’ll be some inflammation.”

Ayanda blinked through the cloud of morphine floating in her veins. There was a woman sitting on the end of her bed. “Who are you? Where’s Dr Miller?”

The woman smiled. “I’m Dr Reed. I was your anaesthetist. Dr Miller was called away to an emergency.”

Ayanda laughed. “A bladder emergency. Yeah right. Can you tell me if the procedure was successful, then?”

“Oh yes, everything was fine. Give Dr Miller a call in the week. I’m sure he wants to talk to you.”

“Of course he does,” said Ayanda bitterly before sinking down into bliss.

A nurse appeared to let her know that they had contacted Anton to collect her. Did she need to go to the toilet?

Ayanda booked a self-catering cottage in the mountains. She told herself it was for her recovery, but really she wanted Anton to just stop leaving on pointless errands and shoots.

While her husband hiked among the fynbos and took long invigorating swims in the springs, Ayanda lay in bed and read. She had brought her own bedding in case she picked up anything from the resort sheets. She also brought along a bottle of Handy-Andy to wash the toilet before she used it. Her mobility wasn’t great, but she was able to join Anton for walks in the evenings to look at the millions of stars in the clear sky. They kissed, but took it no further.

“Soon,” she said. “A week or two, I promise.”

“I hope so.”

On the eve of Valentine’s Day, Ayanda felt a familiar cloudiness in her groin and rushed to the kitchen to drink a few glasses of water, two cranberry tablets and a Macrodantin; it had come back into stock, although numbers were limited due to demand. By lunch-time she was in pain again.

Dr Goolam was fully booked, so Ayanda found herself back under the disapproving gaze of Dr Pienaar.

“There’s blood in your urine, but no leukocytes. I’m hesitant to prescribe another course of antibiotics if there isn’t infection. You’ve been taking Augmentin quite regularly, I see. If you become resistant to this, then there’s nothing else we can do for you.”

“But the pain is unbearable. Can’t the Macrodantin and the cranberry tablets have affected the test? This feels like every other infection I’ve had before.”

“I don’t know. I’m going to give you an anti-spasmodic. If that doesn’t work I suggest you go back to the urologist. He’ll be able to tell you where the blood is coming from.” Ayanda tore the prescription from his hand, hating herself for returning to this uncaring man. He was only interested in the money she paid to see him.

The anti-spasmodic was, unsurprisingly, ineffective.

On the couch, clutching a hot water bottle, Ayanda decided she didn’t ever want to see another doctor.

Anton was out again: something about a party to thank the crew for all the recent shoots. She was too ill to go.

She pulled herself together for their Valentine’s Day date at her favourite restaurant near the harbour. She wasn’t well, and short-tempered from the pain. He was distracted, unhappy.

Spasmend – mephenesin-paracetamol antispasmodic used for the treatment of an overactive bladder

At home, reeling from the slammed door still echoing in the flat, Ayanda tore into the medicine drawer, discarding the cranberry pills and anti-spasmodics and antiseptics and the antifungals and the emergency antibiotics she had managed to score from the chemist after he’d mistakenly given her prescription back. This was not life.

She was a human, not kindling for fires that refused to go out. She would not accept a future shackled by the fear of pain.

And she refused to believe her and Anton’s relationship could be so affected by her illness. Because of microscopic organisms. Because of pain.

No.

She had to believe it.

It just was not meant to be.

A.S. Fields is an author and short story writer from Cape Town, South Africa