Vincent van Gogh – a few months before his own death – painted the quintessential image of age and despair: Sorrowing Old Man (At Eternity’s Gate). Vincent was not himself aged, but his lifelong mental terrors and utter commercial failure (redeemed too late by the somewhat disgusting art market) infused the image. He had seen many such men and women – the discards of life – and in Saint-Remy de Provence put the oil on canvas in 1890.

He was himself “At Eternity’s Gate”, and would soon pass through it.

For many weeks I have seen the barely-living waiting for the end. I have been very ill and (for lack of a bed, and possibly serial medical miscalculation) was housed with those whose deaths are inevitable from advanced dementia, strokes, cancer, and the general collapse of internal organs that awaits too many of us. I have not been reprieved – my doctors are not quacks – I should not have been there.

The opening line of The Trial by Franz Kafka would not leave me: “Someone must have been telling lies about Josef K., he knew he had done nothing wrong but, one morning, he was arrested.” My doctors told me what was wrong – which I accepted. Yet the arbitrariness of being in the place endured.

The place, ironically named after a bird, is in a Cape Town suburb. Within it, even the garden has thick, interwoven metal pipes on which the old balance; the barriers and the strict enforcement of immobility – patients who might fall and truly damage themselves must only walk with “carers”; electric fencing flickers by night; the days are endless, alleviated by institutional meals of a peculiar horror. The TV screens are broken, blank and black.

The place has many names – “frail care”, “old-age home”, “primary care” in one wing, and so forth. But consider the numbers and conditions of those trapped there.

Senile dementia is a form of progressive mental relapse, often confused with delirium and inner decay. One woman wanders the sterile corridors whimpering “Pushing! Pushing!”. It’s the only word she seems to know. Solitary thoughts circle each other endlessly. The night is early and bleak, with weeping and screams: “Where am I? I want my mother!” Many merely slump in terminal anguish; they have frosty scalps, often cannot move. They are subject to night terrors.

At my small table I sat with the ex-farmer with skin cancer; a man with an inoperable brain tumour; Ms “Pushing! Pushing!”, and a silent sad lady – silence being the mark of every meal, some of obscure provenance.

Some of the “patients” (as they are euphemistically known) do have visitors – mainly grown children. Yet most do not; they have been abandoned here – at great cost – because their past homes can no longer sustain them, or despair at what is happening. Most are white – Cape Town has become a dumping ground for the pale-skinned unwanted.

Many of the nurses are brought in from far lands (Uganda is one) for excessive shifts and meagre pay. The major beneficiary of this raked-in cash is a profit-making entity. There is some state surveillance: yet one exercise I witnessed was concerned with the width of the tablecloths.

The lists of those waiting for the death camps is immense – Cape Town is a fragmented city of the old and radically infirm. Vincent would have recognised them.

Then, by night, some staff mock and deride their charges – echoing bursts of mirth are interspersed with howls of rage and laughter soon followed by forced marches of the disabled (often with walkers) to predominantly shared bedrooms.

The reigning emotions – perhaps now known or disregarded by those who pay for their old folks’ invisibility – are fear and excruciating loneliness.

Is all this evil? Not in conventional terms. Most nurses begin each day with hymns – the beautiful lyrics of the faithful sound out – and they do help the hopeless when they can. Yet I cannot forget the 98-year-old former farmer in my small ward: his utterance was to curse (or perhaps pray to) the Divinity who has rewarded his life with incoherence and agony. He has skin cancer. “O God!” he cries – “My Liewe Here Jesus!”. A prayer or a curse? I cannot tell. He tries to walk but a century of mobility in the sun has gone.

Youth and beauty are also long gone – yet, in a parody of flirtation, many move their eyelids in a species of heartbreaking coquetry…

All belief quails. A God whose intervention in our lives comprises loss and pain and despair can scarcely be believed in – or does not exist in our frightening and infinite Universe. This then is His reward for belief.

In war, the dead and dismembered are swiftly hidden; they would evoke the will to flee combat, as perhaps they should. In a book I read recently, Koko by Peter Straub, strangers repeatedly approach Vietnam vets and ask: “What’s it like to kill someone?”

The families of those brushed off like human offal should go and see. DM

Peter Wilhelm is a novelist, poet, and journalist.