It’s remarkable how much some of us rely on that which is written or coded in law, ethics or religious texts to shape what we should expect of the world or the society we live in. The Constitution, the Hippocratic Oath – these are foundational documents which supposedly embrace our common humanity; scripts that prompt and guide us to to aspire to our very best selves, our higher natures. Especially when it comes to a fellow human being, vulnerable and in need.

Reality, however, is not pretty. In fact, it could be downright ugly, especially on Twitter, that occasional sewage pipe of amplified cruelty.

Daily, in the real world, people are turned away from both public and private hospitals. Either they don’t have enough money to be treated or, in the case of a public hospital, there just isn’t the space or the resources. Sometimes it’s just because medical staff don’t give a toss. Years ago a young woman I knew and who was critically ill died when an ambulance driver who had been asked to transport her to a tertiary hospital refused as it was 5pm and he was knocking off.

“So, report me,” he challenged the attending doctor as he strode off into the dusk.

That’s just the way it is. It shouldn’t be, but there we have it.

About two weeks ago Corrie Le Grange’s tragic story escaped the confines of his Edenvale home and made it to the media. Le Grange, a businessman, weighed 450kg and suffered from ascites – the collection of fluid in the peritoneal cavity which causes abdominal swelling and is often related to liver disease. Le Grange had told journalists that he had been turned away from four private hospitals because of his size. While he did not belong to a medical aid, Le Grange said he had been prepared to pay cash for treatment.

After this the story appeared to take on a happier sheen when the Gauteng department of health rushed to the rescue undertaking to treat Le Grange at the Charlotte Maxeke Academic Hospital in Parklands. Le Grange was removed from his home with specialised equipment, loaded into a van with his custom-made bed on a trailer hitched behind and admitted. On Tuesday, he died in ICU after contracting pneumonia.

Apart from the act of kindness by the Gauteng health department, the offer also served to provide some positive publicity for the oft-maligned (and justifiably so in some instances) South African public health system.

Just hours after Le Grange’s death on Tuesday #CorrieLaGrange started trending on Twitter.

It was Eyewitness News’s Alex Eliseev who tweeted, “#CorrieLaGrange Family has told EWN Corrie died after contracting an infection in the ICU section of the Charlotte Maxeke hospital.”

To which journalist Nickolaus Bauer replied “No sympathy for #CorrieLaGrange. What disease causes 450kg obesity? He was always going to die. Held an ICU bed that could have saved someone.”

Followed later by “To blame anyone except #CorrieLaGrange for his death is reckless. Obesity is a self inflicted medical condition – not an unlucky disease” which, of course, sparked howls of outrage (and some support).

Bauer was charged with “fat-shaming” and lacking compassion by writer Liesl Jobson who explained it was difficult to understand his insensitivity. Others thought Bauer unkind and clarified that no one knows what the underlying causes were for Le Grange’s excessive weight gain. And besides, whether this was psychological or physiological, is irrelevant. Le Grange had to live and suffer with the condition, and at the time of his admission was critically in need of medical care (which he was prepared to pay for).

Bauer was supported by Dr Jonathan Witt, who describes himself on Twitter as “not your average man or doctor/Opinionated and controversial with a grand sense of humour/Never mistake an opinion for evidence/Anaes/Crit Care/EM/Trauma” and who tweeted “Annoying that @NickolausBauer is being attacked for accurate journalism correctly reporting the #CorrieLaGrange story for what it is.”

Witt went on to offer the expert diagnosis that “Ascites is not a disease. Nor is it a condition or a sign of disease which causes weight gain of 400kg. That’s KFC.”

Tut, tut. Beside manners Dr, bedside manners.

There might be many who subscribe to the profit-driven American model of healthcare and who may well agree with Bauer and Witt that Le Grange was the architect of his own ill health and was, as a result, somehow undeserving of medical care.

In this world it is those who own gym cards, who “take care of themselves”, earn enough to afford medical cover, who should, can and do expect, or demand the highest level of care. These are precious, worthy, exemplary, thin, lean, beautiful lives.

Bauer and Witt pointed out that Le Grange was “never going to make it anyway” and placing him in ICU deprived someone poorer or more deserving of the bed.

We all know that doctors who work in this country’s overburdened and under-resourced public hospitals are often called on to make godlike choices about who will live and who will die, who will receive immediate treatment or who has to wait. Do you treat the gangster with the knife wound before the pensioner who is having a heart attack?

These are the impossible choices that have to be made. But they are often made with compassion and kindness. Sometimes they are not, and that is human.

But the attitude that those individuals who are ill, who suffer from a “preventable” disease, are somehow less deserving of medical care than those who “take care of themselves” is one that has grown with the corporatisation and commodification of medical care. The reasoning here is that healthcare is a privilege and not a right. This is the case in the US (which is why Obamacare exists) but not in many countries in the rest of the world, including Europe where universal public health care is available to all citizens.

Any party in Europe advocating for limitations on universal health care would be committing political suicide. It is only in the US where it is regarded somehow as “socialist” instead of humane and decent.

But life is never simple. It’s a lottery of sorts. Many things make us ill or kill us. Pollution, poverty, speeding cars, Olympic athletes with guns. Even a gym bunny who’s banting and obsessively checking his blood pressure – a young man in the apparent peak of health – could suffer a heart attack while pumping iron in the gym.

Are we to say in this instance that “you brought it on yourself” that you are undeserving in your hour of need of medical care and attention?

And when you didn’t “deserve” your illness or injury, as was the case with the pedestrian in KwaZulu-Natal who died after he was knocked down by a car and turned away from two public hospitals because of ignorance and bureaucratic bungling?

It is illegal for any hospital in South Africa to turn away a patient who is brought to an emergency room. Section 27 (3) of the Constitution enshrines the right “that no one may be refused emergency medical treatment”. The patient who is indigent and who is brought to a private hospital needs to be stabilised before being redirected to the nearest public hospital.

And while it all looks good on paper, it is sadly, a right that is frequently violated. Try walking through the doors of a private hospital without a credit or medical aid card. Clerks are terrified that they might lose their jobs should they deviate from the detailed check-in procedures.

And the irony is many medical staff surveyed on their attitudes towards assisted suicide or euthanasia or abortion have claimed that they are “against it” because of their religious beliefs and ideas of the “sanctity of life”.

But sometimes bureaucracy and money can get in the way even the truest believer.

In the end, the least we can hope for when we are ill or dying is a modicum of compassion and kindness. Le Grange was, by all accounts, a kind man who did much to serve his community. Using his suffering and clearly painful death to shame him and others, is just inhumane. Which is why we need to continue to try to make the Constitution or the Hippocratic Oath living, breathing documents and not just moral lodestars. We are all, including Corrie Le Grange, entitled to medical care. DM

Photo of Corrie le Grange by Cornél van Heerden, Netwerk24.