In the Midst of Life

MUNABLE TO DIE

Hospitals in the early in 1950s were small, enclosed worlds, especially for nurses. We lived communally in the nurses’ home, and all our meals were taken together. Consequently, we exchanged news of hospital life all the time, so whilst I did not directly look after Mrs Ratski after the first five or six weeks, I was able to keep up with her progress, and made a point of doing so.

Mrs Ratski recovered sufficiently to go to the convalescent home attached to the hospital. It was a lovely house, with gardens sloping down to the Thames, which she seemed to enjoy.

The nursing staff tried to teach her how to manage her colostomy, but she did not understand, and seemed incapable of learning. She just muttered to herself, and poked it (the gut has no nerve endings, so can be touched without causing pain). She seemed intrigued, but quite incapable of understanding how to cope with it. After three weeks in the convalescent home, it was decided that she could return home under the care of a district nurse.

A hospital car brought Mrs Ratski home. Her daughter-in-law, Karen, watched with dismay as the driver helped the old lady out of the car, up the garden path and into the sitting room. She went straight to the sofa, muttering to herself, and pulling her shawls round her shoulders.

The district nurse arrived, kindly and helpful.

‘Where is she going to sleep?’ she enquired.

‘I don’t know. She slept on the sofa before.’

‘She can’t do that now – this sofa is not suitable. I can arrange to have a bed sent from the social services. It’s wonderful what this new National Health Service can provide, isn’t it? I’ll go now, and come back this afternoon.’

A hospital-style bed arrived and the men put it up; the sofa was put in the garden shed. Karen watched the whole proceedings, and bit her lip. Her nice sitting room was ruined.

The district nurse returned in the afternoon.

‘I’ve got sheets and pillowcases, and cotton blankets that can easily be washed, and all free from the NHS. Isn’t it wonderful?’

Karen was not so enthusiastic. Washing blankets was not something she had anticipated.

Mrs Ratski sat on the edge of the bed looking uneasy, and still muttering.

‘I don’t know what you are saying, dearie, but let’s get these clothes off you, and into bed, shall we?’ The nurse turned to Karen. ‘I’ve got to show you how to clean a colostomy.’

‘What’s a colostomy?’

‘Oh, dear. Didn’t anyone tell you she’s got a colostomy? Well, briefly, the rectum has had to be sealed, and the colon is opened on to the skin surface and the body’s waste product goes into a bag. I’ve brought a supply of colostomy bags with me to leave with you.’

Karen didn’t fully understand until she saw her mother-in-law’s abdomen. Two huge and angry-looking scars ran the length of the wrinkly old skin, and on the left hand side a pink, protruding thing burst on to the surface. It was covered with a plastic bag containing brown liquid and had sticky stuff around the edges. Mrs Ratski looked at her abdomen, and poked the bag, and tried to pull it off.

‘No dear, don’t touch.’ The nurse pulled her hand away. ‘She’s been doing this all the time in the hospital, they tell me. They can’t get her to understand that the bag has to be left in place. Have you seen one of these before?’

No, and I can’t bear it! I just can’t bear it. I think I am going to be sick.’

‘You’ll get used to it, dear. The first sight is always the worst. The bag has to be changed when it gets full. It’s not so difficult when you get used to it. And anyway, I’ll be coming in morning and evening to help you.’

The nurse pulled the bag off and wrapped it and its contents in gamgee paper tissue. The huge pink thing, raised from the surrounding skin, looked like a sea anemone attached to a rock, thought Karen, as she watched rigid with horror and disgust.

‘It is important to clean the area carefully, otherwise the skin can get very sore,’ said the nurse helpfully. ‘Watch me.’

Deftly she cleaned around the colostomy with sterile water and applied zinc cream. ‘I’ll leave this with you,’ she said.

‘I can’t do that!’ said Karen in horror.

‘I think you will have to, dear. Usually a patient learns to do it herself. But from what I have read in the patient’s notes, I doubt if your mother-in-law will ever be able to.’

‘I can’t, I know I can’t,’ said Karen plaintively.

‘Well, perhaps I can come in at lunchtime to help you out for the first few weeks.’

‘Few weeks!’ Karen was alarmed. ‘How long will this go on for?’

‘I can’t say, dear. No one can. But she will have the colostomy for the rest of her life. Now, we must talk about other things. What is she going to do when she needs a wee? She can’t get upstairs. What did she do before?’

‘She went in the garden.’

‘Oh, so you’ve got an outside lavatory. That’s useful.’

‘No, we haven’t. She went behind the blackcurrant bushes.’

The nurse was shocked. Karen explained how she’d wondered where the old lady did her business and had been totally horrified when she first spotted her crouching outside. She’d tried talking to Slavek about it, but he’d been unwilling to broach the subject with his mother.

‘Well, she can’t do that sort of thing now. She will have to have a chamber pot. Have you got one?’ Karen shook her head. ‘Then I will get one from NHS Supplies.’

The nurse packed up her bag. She was kindly, and saw Karen’s agonised expression.

‘Don’t worry, my dear. The first few days are always the worst, and I’ll be popping in every day. You’ll soon get used to it.’

Karen went upstairs to her bedroom, and threw herself on the bed, and cried as she had never cried before.

The days stretched into weeks, and Karen never did get used to it. She could not bring herself to touch the colostomy, so Slavek did. He did not find the task difficult or nauseating. He had cared for farm animals in his youth, had attended birthings, squeezed teats, cut abscesses, applied poultices, and a colostomy was much the same. Added to which, he wanted to spare Karen the burden. The district nurse was true to her word, and came in twice a day, often three times.

Karen kept the children away from their grandmother as much as possible. After school they went up to their bedroom to play, and she joined them. To reach the garden they had to pass through the living room and kitchen, so she discouraged this, taking them to the park instead. Slavek did not like it, and thought her determination to keep the children away from his mother was wrong, so he asked her why she did it.

‘I don’t want my girls to see that sort of thing. They are too young.’

‘They’re not. Children need to see everything in life. Old age, sickness, birth, death, everything.’

‘It upsets them.’

‘That’s only because you tell them not to be upset. You put the idea into their minds first. If you said nothing, they would take it in their stride. Children always do.’

Karen changed tactics.

‘Well, anyway, they can’t talk to her.’

‘But if you let them they would learn some Latvian.’

But she wouldn’t. He watched with sadness as Karen shepherded the girls carefully around the opposite side of the living room, as far away from their grandmother as possible, and upstairs to their bedroom.

One day she said: ‘I’m going to ask the nurse to get a screen from supplies.’

‘What for?’

‘To put around the bed, so I don’t have to see her using that chamber pot. And I don’t think the girls should have to see it, either.’

He sighed. ‘You’ll do more harm than good trying to protect them like this.’

But in the evening he came home to find screens around the bed, and his mother completely hidden from the life going on around her. The girls, being children and endlessly curious, would peep behind the screens and stare at their grandmother, as though she were an animal in a cage. Then they would giggle and run away.

He could see that Karen was growing increasingly resentful, and discussed it with the nurse. He felt guilty, and was bewildered by his feelings of guilt. Even though he and the nurse attended to the colostomy Karen had a lot of extra work, with washing, changing the bed, emptying the chamber pot, cooking. He was a practical man, and saw life in practical terms. What he did not see was that Karen’s main resentment was that she did not have the house to herself. He had been brought up in a large, gregarious family. They had had only one large room for everything – living, sleeping, cooking, eating. Babies were born in that room. Illness was nursed there, and he remembered, from long ago, his grandfather – his mother’s father – dying in the room. And now, here was his own mother dying in his room, but completely cut off from his family. He felt guilty about it. Guilt seemed to come at him from all sides: Karen, his mother, the girls. He had let them all down. But how? What had he done wrong? The nurse listened but could only sympathise.

And what of Mrs Ratski in all this? She was the most pitiable figure. Within the space of three months she, who had been a vigorous, determined old woman, had been reduced to an invalid. And her mind and character had subtly changed also, Slavek noticed. The strong, wise matriarch whom everyone in the family looked to for guidance had gone, and a whining, querulous old woman he did not recognise had slipped into her place.

Mrs Ratski was turning in on herself more and more each day. Her thoughts seemed to be centred entirely upon her colostomy. She spent hours muttering to herself, picking and poking at the bag. The old lady who had been the strength of her family throughout decades of war, suffering and foreign domination; who had survived a prison camp; with all her strength, all her resolution to get to England; all that she had endured in hospital; everything was reduced to a pinpoint of focused attention – her colostomy.

There was no doubt that her mind was slipping away from her. She could not understand where she was or why she was there. Probably the acute illness, the anaesthetic, and the drugs had affected her mind, however, the cultural isolation must have had something to do with it, too. The language everyone around her was speaking confused and bewildered her. But it may be – in fact it probably was – that her brain cells, together with all the other cells in her body, were growing older day by day, week by week, and dying, as all living things must die.

One can hope that she was losing her mind, because it would have been a merciful release from loneliness. She had lost all that was familiar, her home, her daughter Olga and grandchildren, her friends, her country and the rhythm of her life, her language and her Church. Everyone around her was doing things to her that she could not understand. No one, apart from Slavek, showed her any love, and she loved no one. The hope must be that senile dementia was laying its kindly hand on her mind, inducing confusion and forgetfulness. Awareness and remembrance of loss would have been more cruel.

The year was drawing to its close, and the nurse was behind the screens tending Mrs Ratski when a quarrel erupted between the young couple.

Karen unexpectedly said: ‘I’ve decided to take the girls to my mother’s for Christmas.’

‘Why?’ asked Slavek guardedly, although he already knew the answer.

‘I can’t face Christmas here, with your mother in the room.

How can I put up a Christmas tree and hang paper chains? We can’t have presents under the tree and a nice Christmas dinner in there; I can’t invite people in. No, we’re going to Mum’s this year. I’ve told the girls and they are looking forward to it. You can come, if you like.’

‘But your parents don’t really like me. They won’t want me for Christmas.’

‘Well, you can please yourself. Mum says you’ll be welcome if you want to join us.’

‘But I can’t leave my mother here on her own!’

‘It’s not my responsibility. I’m doing what I think is best for the girls. I want them to have a good Christmas.’

He became angry.

‘How can it be a “good Christmas” if you take them away from their father? That’s not goodness, that’s selfishness.’

‘Don’t you call me selfish! I want—’

He butted in before she could finish the sentence.

‘I remember when I was a boy, my grandfather died in our home. It was Christmas time, and all the family were there. We were children, and we just accepted it. We all played, and had a “good” Christmas.’

‘Don’t you keep reminding me of how you were brought up! Peasants, that’s what you were, peasants. No wonder my mother doesn’t like you! Well, I’m not a peasant, thank you very much. I was properly brought up, and I’m going to see to it that my girls are, too.’

‘I don’t know what your “proper upbringing” means, if it means denying the girls their grandmother. And she is their grandmother. And they are not just your girls. They are my girls too.’

‘She’s not like a grandmother. She doesn’t do things with them. She can’t take them out or play with them like grannies do. She just sits there, muttering and mumbling, and poking that “thing”. I can’t stand it any longer, all the washing and trying to get it dry, in this weather. And the smell! I can’t stand it any more. However much I wash, it’s still there. The nurse says if she didn’t keep poking at that “thing” it wouldn’t leak and the bed wouldn’t get dirty, but she won’t stop. She keeps poking and picking, and I can’t stand it, I tell you, I can’t stand it!’

Karen had worked herself up into a hysterical frenzy and was sobbing. Slavek put his arm around her and she became calmer.

‘Why doesn’t she die, Slav? Why can’t she just die? That’s what she wanted. That’s what she came here for.’

‘I know. I’ve thought about it a lot. She nearly died that morning in August. But we called the doctors, and now she’s alive, and can’t seem to die.’

‘If only I hadn’t gone to the phone box.’

‘You only did what you thought was right. I did worse. I signed the consent for operation form.’

‘Why did you?’

‘Well, there wasn’t really any time to think. There was a sort of pressure to sign. No one said anything, but it was expected of me, so I did.’

He brooded gloomily for a while, and neither of them spoke. Karen could see his unhappiness and felt sorry for her outburst. She squeezed his hand, and saw his manliness crumble into tears that he tried to hide.

‘If I had known what was going to happen,’ he continued, ‘I would never have let them do it to her. But I didn’t know. How could I?’

‘If you had refused to give consent for the operation, would it have made any difference, do you think?’

He thought for a bit, and wiped his eyes and blew his nose.

‘No, I’m not sure that it would. I think they would have operated anyway.’

‘Then you can’t blame yourself.’

‘But I do. I feel guilty all the time. Guilty because I’ve made life hell for her, and guilty because I’ve made life hell for you.’

‘Is it wicked of me to wish that she had died last August, Slavek?’

‘I don’t think so. Death is natural. It comes to us all.’

‘Can she go back to Latvia?’

‘I can’t see how. How could we get her there?’

‘She’ll have to go into a home of some sort.’

‘That’s what I’m beginning to think. I didn’t want it, but I can’t see any alternative.’

Slavek and Karen discussed it with the district nurse who made enquiries. Two local council-run old peoples’ homes were full and agreed to put Mrs Ratski on a waiting list, but warned that it might be a year or two before a place became available. They could enquire about private nursing homes in the area, but were told that Mrs Ratski would upset the other residents.

Christmas came. As soon as the school holidays started, Karen took the girls to her mother’s. Slavek was left alone with his mother. He attended to her physical needs, and the district nurse called as before. Then Karen decided to stay with her mother – Slavek was devastated. He was lonely and missed his little girls most dreadfully. On Christmas Eve he got drunk and slept for two days, with a couple of bottles of vodka by his bed.

He was awakened by repeated banging on the front door. He staggered downstairs, unkempt, unshaven, and wrapped in a blanket. It was the district nurse.

‘What’s been happening? I tried to get in this morning. I saw your bike was here, but you didn’t answer, and I knocked and knocked.’

‘What time is it?’ His voice was slurred.

‘It’s four o’clock. I haven’t seen your mother for days. Has she been away with you?’

‘No. She has been here all the time.’

‘Well, I must see her now.’

They went into the sitting room.

‘It’s bitterly cold in here. Hasn’t the poor old lady even got a fire? And it smells dreadful. Who has been looking after her? Where is your wife?’

‘My wife has gone to her mother’s and she’s not coming back.’

‘Not coming back? Oh dear, that won’t do. I will have to report that to my supervisor. The old lady can’t be left alone all day while you are at work. But I’m sure arrangements can be made to care for her – Meals on Wheels, a home help – yes, there is a lot of support we can give you.’

‘I don’t want your bloody support! I want my wife and daughters. They’re not coming back, I tell you.’

‘There is no need to shout, young man. I heard you, and don’t use bad language to me!’

‘She will have to go into an old peoples’ home.’

‘That’s not so easy, as you well know. The Council Home is full, and your mother is on the waiting list. Have you tried private nursing homes?’

‘Yes, and they won’t take her. Each one we tried said she would be disruptive and would upset the other residents.’

‘Well, all I can do is organise as much home support as possible for her. Now, I must clean her colostomy. She’s in a dreadful mess, faecal discharge everywhere. When did you last attend to it?’

‘I can’t remember. A few days, perhaps…’

Muttering words of disapproval, the nurse started work.

‘And what has she been eating recently, if your wife has not been here?’

‘I don’t know. Porridge, I suppose. She likes porridge.’

‘Well, it’s not good enough. We can’t allow her to live on porridge. Meals on Wheels will be arranged as an emergency, from tomorrow. And I advise you to light a fire, young man. It’s freezing in here.’

Clucking her disapproval, the district nurse left.

Slavek did not light a fire. He went to the pub and got blind drunk.

Days passed, day after desolate day, and Slavek was utterly alone. Hatred and resentment built up inside him and he could hardly bring himself to go near his mother – stupid, useless old thing. Why hadn’t she died when she said she would, why was he stuck with her now, a miserable old bag of bones with no mind? Why couldn’t she just die? Every day, when he got home from work, he was hoping against hope to find her dead – but she wasn’t. She was always there, in Karen’s nice sitting room, where the children should be playing by the fire, and having crumpets toasted on the red coals, and stories read to them before bedtime. Every evening he spent in the pub, drinking until closing time.

Men in Slavek’s position – having lost wife and children, heartbroken, lonely, angry, frustrated, drinking more and more – can quickly spiral into a crisis from which they cannot escape. Self-neglect, repeatedly arriving late for work with a hangover, unreliability, led to warnings from the management, which were only half-heartedly observed, then ignored. Slavek was dismissed. He was too ashamed to tell Karen that he had been given the sack, so he drew his dole money, sent half to her, and spent the rest in the pub. He had never been a good manager; Karen had always handled the family finances. Perhaps he thought that he was doing enough by sending her money each week; perhaps his brain, fuddled by drink, refused to accept the inevitable consequences of the fact that no money was going into his bank account.

In March he received a letter from the bank manager, saying that there was insufficient money in his account to pay his monthly obligation to the building society. Slavek ignored it. April brought a similar letter. He didn’t even open it. Each month a letter arrived, but was ignored.

Karen knew nothing of all this. If she had, she would have done something about it. But by the time August came and Slavek was six months in arrears with the mortgage, the sum outstanding was so huge that there was nothing she could have done to rectify the situation.

In September, the building society obtained an order for distraint. The house would be repossessed and sold to recover the loan the society had made. Slavek didn’t really understand what had happened until the bailiffs arrived and ordered him and his mother out of the premises. The district nurse arrived at the same time, and, as no provision had been made for the old lady, she took control of the situation and a week’s grace was allowed.

The Court Order was the first news Karen had of the financial crisis. She was utterly distraught and rushed over to see Slavek. How had it happened? It couldn’t have happened suddenly. There must have been warning letters. Where were they? Slavek rummaged around amongst a pile of unopened letters and produced a couple.

‘You fool!’ shouted Karen. ‘Why didn’t you let me know? Why did you ignore them? Now look what’s happened. We are going to lose our home. Don’t you understand? They are going to take our home away and sell it. We will be homeless.’

At last Slavek understood. But it was too late. There was nothing either of them could do. Karen returned to her mother, and stayed there. Slavek moved into a men’s hostel, and drink took over his life.

As soon as the nurse informed the council of the eviction order, they assumed responsibility for Mrs Ratski. She was taken to a short-stay home for the elderly, but was terrified by the new surroundings, and became so disruptive that she had to be moved. This was a pattern that repeated itself several times. With each new move she thought she was going to be poisoned and wouldn’t eat or drink. With puny strength she fought the staff and other residents and had to be forcibly restrained.

Mrs Ratski ended up in a psycho-geriatric ward where she could be kept under nursing care and more or less continuous sedation. All her fear, suspicion and aggression faded away and she became quiet and docile. She no longer resisted the nurses, and meekly swallowed the tranquillisers, and everything else that was given to her. Every so often she developed a chest infection or a kidney infection and obediently she swallowed the antibiotics. She lived like this for three years, not able to understand where she was, or how she had got there; maybe not even who she was. She could not speak to anyone, nor comprehend a word that was said to her. She had no visitors. The hospital chaplain arranged for a Latvian priest to come, but she stared at him strangely and did not speak. Her loneliness and isolation were more total and more terrible than if she had been transported to a distant planet inhabited by aliens.

The end came in 1957 when she fell out of bed and broke her pelvis. It was virtually impossible for the pelvic bone to mend because it could not be immobilised. An operation was performed to try to pin the bone, but the wound did not heal, and staphylococcal infection developed, which did not respond to antibiotics. Generalised septicaemia set in. From this, Mrs Ratski died, alone, in the brittle whiteness of an English hospital.

This is a family tragedy that could only have been prevented by the old lady’s death. Yet there is not a doctor in the civilised world who would fail to treat a simple intestinal obstruction. Nor, I think, are there many lay people who would say, ‘Leave her alone – she must die.’ No one could have foreseen that it would lead to the break-up of a family, and the downfall of a good man.