Matron said nothing, but I blundered on.
‘She thinks she is in a concentration camp, you know, and that we are using her as a guinea pig. She can’t understand what we are doing, or why. She is terrified all the time, terrified of us.’
‘Yes, I know. That is something no one could have anticipated.’
‘But she has lived in fear, Matron, for weeks. It is tragic, terrible. I can’t bear to see it.’
I was getting tearful, and had to stand up and walk about again. ‘And there’s another thing. All these injections she’s having. Dozens of them, daily. And now we’ve started paraldehyde. It’s mind-bending, Matron. It replaces one madness with another, different sort of madness.’
I walked the length of the room and back, then sat down.
And there is another thing that worries me, Matron. All this business about “she must have”. It is written in her notes. “If drugs are refused, to be injected.” And we, the nurses, have to inject them. It seems wrong.’
A nurse must obey medical orders.’
‘She does refuse drugs, all the time, so we hold her down and inject them. Isn’t that assault? And who commits the assault? The doctor who orders it, or the nurse who does it?’
‘I cannot answer these questions. Perhaps a lawyer could, but I doubt it. If life-saving drugs are to be given, they must be given, and any court of law would uphold the medical necessity to save life.’
‘Well, I don’t agree with the law!’
‘Nurse, you are young and passionate. You are trying to understand a subject too deep for understanding. Death used to be as you have described it – your grandmother had a heart attack and just died in her husband’s arms. That is how it used to be for the vast majority, but not any more. Medical science has found hundreds of death-defying tactics, and, as this century unfolds, thousands more will be available to us. We do not know where it will end. Perhaps we will come to a point when human beings are unable to die.’
‘That is a frightening thought, Matron.’
‘Yes, it is.’ Matron stood up, all four feet eleven inches of her, indicating that the interview was over.
‘I advise you, Nurse, not to talk too freely with other people on this subject. You will not be understood. In fact you may be positively misunderstood. All sorts of sinister interpretations could be drawn from your remarks. It is a dangerous subject.’
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.
In the Midst of Life Page 4