Floor1 is food for thought, but digest slowly

Dietician Carla Chait’s novel, Floor1, feels a bit like a food supplement rather than a nourishing meal – and that’s intentional.

Chait is trying to convey the paucity of care in a South African state hospital, where the turnover of patients, limited budgets, poverty, educational levels, and conventional medicine often renders caregivers impotent to make a difference.

The novel, Chait’s first, is a fictional account of her community service year as a dietician. “During my BSc undergraduate, I read widely on diet and natural medicine, and it was at this time that I discovered macrobiotics,” she says. “I was interested in physiology and the potential that food has to transform us physically and spiritually.”

However, these ideals were punctured during Chait’s community service, when she landed up working within a paradigm that made no sense to her but nevertheless had to toe the line. In an attempt to express her experiences, she began to write stories about a young dietician.

“The narrator is part of a team of healthcare professionals caring for a patient and has very specific and thus limited tasks,” Chait says. “She becomes increasingly distressed by her limitations, her own jadedness, and the neglect she perceives everywhere.”

Chait stresses that the novel is fiction, saying, “The narrator holds on to her beliefs in a way that I was too afraid to as a community-service dietician. Although she despairs not ever really getting anywhere in helping her patients, her compassion in recognising them and standing up for them goes a long way.

“The narrator is confronted by many horrors at the hospital – disease, wounds, injuries, distress, emotional vulnerability,” she says. “There’s a sense of overexposure against which she must protect herself. She confronts all sorts of suffering, but what she finds particularly disturbing is the pervasive air of despair. She’s troubled by how sick people are, how many sick people there are, and how little she can do to actually help them.”

There’s an impersonality, almost a loneliness, to the novel. Doctors are faceless and nameless, rotating between departments, making it difficult for the narrator to form lasting relationships with them, and nurses are equally anonymous and disinterested. The narrator also struggles with the other dieticians in her department, where no-one cares about her seemingly wayward opinions.

“The narrator traverses the hospital daily – up and down floors, through wards, areas and sections – but she keeps returning to floor 1, to the department, feeling empty. The title of the book reflects the impasse that the narrator finds herself in: lost and constrained by her position,” Chait says.

Chait’s writing is spare but hard-hitting, often most powerful in what it omits from the sentence. “I take out Mr Nyathi’s folder and write today’s date and then ‘Deceased’ on the back page. I stare at the date for a long time before refiling the file,” she writes.

Patients reflect the reality of South Africa – there are HIV-positive patients, criminals, young mothers, victims of violence, and those with psychological issues. Some appear to hang around merely to use the office phone.

“The prisoners are chained across their wrists and ankles so that they hobble along floor 1 chiming,” she writes. “Every man has at least one security guard with him. The camaraderie between the prisoners and their guards intrigues me. ‘Why?’ Anneke has asked. ‘You don’t see that kind of relationship between the staff and the patients in the wards,’ I told her.”

There’s a bit of comedy as the narrator struggles to get through to her patients about nutrition. “Brown sugar doesn’t have any fibre in it,” she tells patients in the slimming clinic. ‘Even Huletts?’ I don’t answer that.”

She conveys dismay at the domestic situation of a lot of patients, asking nurses who one very sick mother in the ward has to care for her at home. She describes mothers who pester the hospital for free formula and then dilute it to make it last longer, and babies who are at crèche all day and whose mothers have no idea what they are being fed there.

The book is peppered with nutritional supplements – “feed” rather than food. It’s a metaphor for the passivity of patients, the lack of holistic care in conventional medicine, and the struggle of dieticians to change eating habits.

“Under today’s entry I put: Dietician. Patient provided with 2L of diluted Energade (approximately 580kcal, no protein) and one 240ml Enlive sip feed (250kcal, 9g protein). If I didn’t have these numbers, I’d have nothing to write. No-one’s interested in my opinion on the situation” she writes.

She’s frustrated with the hospital’s obsession with calculations and numbers, with “right and wrong foods”. “I’d like to know what everyone is writing all the time. You calculate the requirements, order the feed. What are they doing the whole day? Filling out forms, banging on the calculator, more writing… They’re giving themselves lots of work to do. Lots of important work.”

Floor1 is a hard-hitting novel that offers an unusual glimpse into the difficulties of working in the South African state sector and conventional medicine’s inability to change lives for the better, particularly when it comes to diet. It’s food for thought.

• Julie Leibowitz is the sub-editor of the SA Jewish Report.
• Photo credit: Gavin Arnold Goodman of Drawn to Light Productions