UNNATURAL DEATHis rare to predict one’s own death, or to meet anyone who has done so. But occasionally it happens, and I knew such a lady.Ratski was Latvian, born in the 1880s, and virtually her whole life had been lived under the shadow of military conflict. She was a simple peasant woman, and she was immensely strong, both physically and morally.1941, the German armies marched into Latvia and brutally crushed the resistance. Her husband and four sons were forcibly drafted into the German army, and they all died except Slavek, her youngest child. Slavek survived because he was taken prisoner of war by the British. It was the luckiest day of his life. In England he was a free man, and he worked on a farm, which is where he met Karen. Slavek was a good-looking boy with wide blue eyes, blond curling hair, and an infectious joie de vivre that made everyone he met feel good. Karen was a Land Army girl, and the work was hard, the day long, and she was often exhausted at the end of it; but not too exhausted for assignations with Slavek.the war, in 1947, they married. He worked as a garage mechanic and she as a hairdresser, and between them they saved up enough money to put a deposit on a terrace cottage and take out a mortgage. They were proud and happy property owners, and they had two little daughters who were six and seven at the time this story begins.day Slavek received a letter from his sister Olga, in Latvia, saying that their mother had suddenly announced that she was going to die, and that she must see her only surviving son first. Accordingly, she had applied for a visa to leave the country.more was heard for fourteen weeks and Slavek supposed that the whole thing had been forgotten. He had not reckoned with the resolution of a determined old lady! Alone, and with only a spare pair of boots and an extra shawl, Mrs Ratski had set out to walk across northern Europe, to reach the French coast, and find a boat that would take her over the channel to England.sounds a fanciful story, but at that time it was not. Millions of people trekked thousands of miles across the length and breadth of war-torn Europe, to reach a destination they thought might be home, or at least a haven from persecution and danger.first that Slavek knew about it was a policeman at the door, saying that his colleagues in Reading had received a phone message from the police in Dover, informing them that an old lady, who spoke no English, had been referred to them by the port authorities. Her only identification was a piece of paper that bore Slavek’s name and address. The old lady was his mother.following day, the police brought her to his house. The meeting between mother and son was deeply emotional. She clung to him and wept, and blessed him in the name of the Virgin Mary and Jesus Christ and all the Saints in Heaven. ‘You are my only son left, my youngest, my fairest, my swan, my hope. To see you again has been my dearest wish. Now I will die happy.’ And she blessed him again.
‘But you can’t be dying. You are not ill!’ he protested.
‘No, but I am old, and I can see the figure of death, the Reaper. I hear the swish of his scythe that cuts down the old grass so that new may grow. It is the way of life. I am content now, and I ask God for nothing more than to die peacefully under my son’s roof.days later Mrs Ratski developed acute intestinal obstruction. Suddenly, and unaccountably, a loop of bowel twisted on itself, a condition that, if untreated, is fatal. Slavek was the first up that morning, and found his mother in great pain on the sofa in the living room where she had been sleeping. She was leaning forwards, clutching her stomach, moaning and rocking herself. She looked up when he entered, and her face was grey with pain, her lips pressed back over her gums and her eyes dull. He went over to her and took her in his arms.
‘Oh, my son, my jewel! It has been a long night, but the morning brings my Slavek, praise be to God.’felt himself panicking, and ran to the bottom of the stairs. ‘Karen,’ he called. ‘Come quickly. Something terrible’s happened.’
‘I must give my blessing to your wife and your children before I go,’ said the stricken old lady.
‘We must get the doctor,’ said Karen.doctor arrived and examined Mrs Ratski as best he could, but she was rigid and he could barely move her. He noted her pain and sweat and rapid pulse. Her temperature was very high. ‘I will give her an injection of morphine, and then I will order an ambulance to take her to hospital,’ he said.was a first-year student nurse at the Royal Berkshire Hospital, Reading, when Mrs Ratski was admitted. The year was 1953 and I was eighteen years old. We had been told to prepare for a woman with an abdominal obstruction of unknown origin, possibly a perforation, and peritonitis. The ward sister told the staff nurse to take me with her and to instruct me in preparation for an emergency abdominal exploration.made ready a bed, a surgical trolley for the examination, an injection tray for drugs and infusions, a trolley for gastric intubation and suction, and a drip stand for glucose and saline infusion. Our patient arrived and the staff nurse took her temperature, which was high, and blood pressure, which was subnormal. Her pulse was thin and racing, and her skin was white and sweating. Her mouth and tongue were dry, her eyes glazed, and she was deeply asleep, breathing slowly – only about six to eight breaths per minute. Our patient was obviously in a state of shock. I was told to undress her.was hovering in the background, so the staff nurse took a medical history from him. He did not know his mother’s age, but thought she was between seventy-five and eighty years old. He informed us that she had been a peasant, uneducated, and had worked on the land since she was about seven. She had married, and borne (he thought) nine children. ‘Had there been any miscarriages?’ He did not know. ‘Had she ever been ill?’ He thought not – at least, he had never been told of any illnesses. ‘Had she ever had an operation?’ He didn’t think so. ‘Was her husband with her?’ No, he had died many years ago.was still taking off all her black clothes, revealing an emaciated body. Staff nurse was a thoughtful girl, and remarked, ‘She looks half-starved, as though she has hardly had a good meal in her life. How did she come to be with you?’Slavek told us the story of her astonishing lone journey across Europe to England. Staff nurse wrote it all up in the notes. ‘Amazing,’ she said, ‘hardly credible. But she is here, so she must have done it. Why did she come?’
‘She told my sister, Olga, that she was going to die, and that she must see me first.’ Slavek could scarcely get the words out, his voice catching as he choked back the tears.
‘Her dying wish, eh?’
‘I suppose so. She told me that she was happy to go now that she had seen me.’nurse was kind and optimistic. ‘Don’t worry. Your mother is in the right place. We can treat this sort of thing. She will soon be well again.’
‘Thank you so much. You are wonderful.’house surgeon arrived. He was very young, about twenty-four, and this was his first house job. Like me, he was nervous and a bit hesitant. He checked Mrs Ratski’s heart and lungs, looked into her eyes, ears and throat, and checked all her involuntary reflexes. He took blood for crossmatching, set up a glucose/saline drip, and put the gastric suction machine in readiness, but he did not insert the gastric tube. He examined the abdomen, which was hard and distended, and applied his stethoscope to listen for abdominal sounds. ‘Hmmm,’ he said, looking very wise, ‘I will call the registrar.’ With that, he left.was told to give the old lady a blanket bath, and to put a surgical gown on her. She was so thin, I thought she might break if I moved her. She could scarcely have weighed more than seven stone. Her distended abdomen, hard and shiny, contrasted strangely with the rest of her. I wondered what kind of life she had had back in Latvia.registrar came, accompanied by the houseman. The registrar was only about thirty, perhaps less, but five years’ experience in medicine can make a great deal of difference. There was no careful hesitation in him. He was quick, confident, and arrogant. He tapped the abdomen and listened.
‘What do you make of it?’ he demanded of his junior.
‘Well, em, I, er, could hear abdominal sounds.’
‘And what did you make of them?’
‘Well, I found, er …’
‘Can’t hear a damned thing that means anything. We’ll have to open it up to see what’s going on. Go and book theatre. Laparotomy, with exploration. Possible gastrectomy, resection, won’t know till we get in there. I’ll go and talk to Carter. See if he wants to do it, or if I should.’ They left.Carter, the consultant, arrived with an anaesthetist. He examined Mrs Ratski and read the notes. The anaesthetist was concerned about the patient’s emaciation and her state of shock. He ordered a gastric tube to be passed and suction to be commenced immediately. He commented that she would not need a pre-med, because she had had morphine. He said, ‘We must have a consent form, and she can’t sign it. Is there anyone here who can?’
‘Her son is with her,’ replied the staff nurse.
‘Get him to sign, will you, Staff?’two consultants left, and Staff took a consent form to Slavek. ‘Your mother must go to theatre for an abdominal exploration. Would you sign the consent form for her, please.’
‘Of course,’ said Slavek, and signed.had been no discussion with Slavek about his mother’s condition; no mention of what an exploratory laparotomy means, still less of what a gastrectomy or resection could entail, nor of the post-operative complications that can so easily arise in old people after major surgery. There had been no hint that perhaps the surgery could lead to a death more agonising, and certainly more prolonged, than the abdominal crisis that had occurred in the early hours of the morning. Neither the doctor nor the nurse discussed with Slavek his mother’s dying wishes, nor her certainty of her impending demise, her astonishing resolution to get to England to see him, and her acceptance of death once she had achieved this. No one asked him, quietly and sympathetically, if he could project what his mother might want. Whilst all the decisions were made about and around her, Mrs Ratski was in a deep, morphine-induced, sleep. But no one suggested waiting until she roused so that she could speak for herself.was when, at the age of eighteen, I started to contemplate death.LIFE SAVEDRatski was taken to theatre within an hour of the ambulance arriving at Slavek’s house, and Mr Carter took the case himself, with the registrar and houseman assisting. The abdomen was incised, and a volvulus was found to be causing the obstruction. Volvulus is the term applied to the twisting of a loop of bowel on itself. The pelvic colon is most commonly involved, and the patients are usually elderly. Manual untwisting of the bowel was performed after deflation of the loop with an aspirating needle, then the gut was examined, and no other abnormality was detected. Gastric suction was continued throughout the operation, and a saline and glucose drip continued. To relieve the pressure on the pelvic colon, a left inguinal colostomy was undertaken, which was intended to be temporary. A colostomy is when a loop of colon is brought out through the abdominal wound on to the skin surface, and retained in position with sutures. An opening is then made into the bowel, and the contents will drain into a bag or bottle.operation itself was relatively straightforward, but difficulties arose because of the anaesthetic. The patient was old, undernourished, and in deep shock. Her blood pressure was very low, hardly sufficient to maintain circulation, so cardiac stimulants and oxygen were given. The patient did not have adequate respiratory drive to breathe, so a tracheotomy was performed. The anaesthetist made an artificial opening through the windpipe, and passed an endotracheal tube directly down the trachea for oxygen and gases to be delivered under positive pressure. The gas used was ether, and Mrs Ratski went into an ether convulsion, which is a serious complication. Antidote drugs had to be given intravenously, the gas was stopped, and a mixture of oxygen and carbon dioxide administered instead. The patient was in theatre for three hours, and for most of that time the anaesthetist was battling for her life. Several times the theatre staff thought she had died, but each time the anaesthetist resuscitated her successfully.Ratski returned from theatre to the ward. Post-operative intensive care units did not exist in the 1950s, so the ward sister and her nurses took that responsibility. We had been alerted that the patient’s condition was grave, and a small side ward had been prepared. The ward sister received the patient and checked her condition, and a nurse was told to stay with her. There were no monitoring machines in those days. A patient’s post-operative condition was maintained entirely by nursing observation and assessment.had been obliged to go to work. He had been told to ring the hospital at midday, and that he could visit in the evening. When he telephoned, he was told that the operation had been successful, but that his mother was still under the anaesthetic. He came to the hospital directly from work, but she still had not regained consciousness. The breathing tube in her throat frightened him, so he asked the sister about it, and she told him that it was only temporary and would be removed when his mother had enough strength to breathe normally. He asked about the blood transfusion entering her arm. What was wrong with her blood? The sister quietly explained that it was normal procedure after major surgery to give blood. An oxygen cylinder hissing away beside her bed alarmed him, but at the same time it reassured him – everything possible was being done for her. Everything would be all right. She was sleeping and looked comfortable, so he slipped away.the second evening, he was alarmed to find his mother’s hands tied to the side of the bed. The sister explained that it was necessary, because his mother had tried to pull the tube out of her throat. His mother turned her head and looked at Slavek, her eyes full of anguish, but she could not speak because of the tube in her windpipe. He stroked her hand and kissed her forehead, whispering, ‘You’ll be all right, mother. They know what they’re doing.’the third evening the oxygen cylinders had been removed, but the tube was still in her throat, and her hands were still tied. Slavek asked about the tube, and the sister said that there would be a ward round tomorrow, so a decision would be made then. He felt reassured, and told his mother that the surgeon would see her the next day, and that everything would be all right.everything was not all right, and we, the nursing staff, knew it.the first instance, our patient’s recovery from anaesthetic had been abnormally prolonged. She had not shown any signs of consciousness for more than twenty-four hours, and when she did recover, she seemed excessively agitated. She had attempted to throw herself out of bed, and had to be restrained by two nurses. She tried to shout, but could not make a sound, because of the tube in her trachea, so she tried to pull it out. We nurses had to prevent her from doing this, and we explained that it must stay in place for a few days. Only then did we realise that she neither spoke nor understood English, and it took us some days before we appreciated how difficult this was going to be. She watched us carefully, and when a nurse’s back was turned she tried to pull the tube out again, and had to be restrained. The naso-gastric tube, which was attached to a machine for continuous suction, was another focus of worry. Then Mrs Ratski discovered the blood drip entering her arm, and had a go at that, too. The night sister had ordered her hands to be tied to the sides of the bed, because during the night when fewer nurses were on duty she would have undoubtedly succeeded.Ratski lay immobile, hands restrained, in terrified silence. Soundless sobs racked her body, and tears streamed from her eyes. She could not swallow, because of the pain in her throat. Her mouth became completely dry and crusted, and had to be moistened and cleaned every hour, but even so her tongue was ulcerated and cracked. She did not pass any urine, so a nurse had to catheterise her, but she held her body completely rigid, to prevent anyone from parting her legs. Did she think she was being raped? I wondered. Maybe she had been, in a prison camp? A muscle relaxant was injected, which she could not prevent, and the catheter inserted.house surgeon, registrar and anaesthetist visited frequently to check her condition. On the fourth day Mr Carter did his ward round. These were always elaborate affairs – the consultant, accompanied by the ward sister, followed by his team of doctors, and another team of nurses who were there to do or get things. It was highly ritualistic, like a visit from royalty. The consultant would go round the beds of his patients, asking questions of the sister, checking notes, ordering another test or another path lab analysis, changing a drug, or the dosage of a drug.Carter approached Mrs Ratski’s bed. She lay still, her lips compressed, only her eyes moving, as they flickered from one white coat to another. Mr Carter read through the notes. ‘I hear you have had trouble with her, Sister.’
‘Yes, sir. She keeps trying to interfere with the dressings.’
‘That is why you have tied her hands, I suppose?’
‘Yes, sir. It was the only way.’
‘Hmm. Well, we can discontinue gastric suction and start fluids by mouth. The blood drip can be removed after this bottle. That will help you, won’t it, Sister? I can’t give any instructions about the endotracheal tube. That’s a matter for the anaesthetist. Everything else satisfactory, Sister? Urine, faecal discharge?’, sir. Do you want to see the wound, sir?’. Get a nurse to remove the dressings.’was at the back of the entourage, so I came forward and removed the dressing. Mr Carter looked at it.
‘Hmm. Satisfactory. You can remove one of the drainage tubes, Sister. We’ll take the other one out when we remove the sutures – we’ll have to take her back to theatre when we close the colostomy. You can do that, Ryder,’ he said to the registrar., sir.’
‘Well, everything satisfactory, wouldn’t you agree?’
‘Yes, sir, very satisfactory.’ said the registrar.they moved on to the next bed. As they went, the tension in Mrs Ratski’s body visibly relaxed.the round had finished, Staff nurse told me to assist her in the removal of the naso-gastric tube. The blood had very nearly run out from the bottle, so she removed that also. With the removal of the suction machine and the drip stand Mrs Ratski looked more like a human being.anaesthetist came and said that he would remove the endotracheal tube under local anaesthetic. Staff nurse assisted him, and I was told to accompany her. The young house surgeon also came to watch, because he wanted to know how it was done. At the sight of another surgical trolley and several doctors and nurses, Mrs Ratski became visibly distressed. She could not make any sound, and her hands were still tied, but all her body language was that of panic. The anaesthetist took up a syringe of local anaesthetic, and, as she saw the needle approach her neck, Mrs Ratski’s skin lost all colour, and sweat poured from her brow. The anaesthetist retreated. He took her pulse rate.
‘It’s gone up to one hundred and twenty. I can’t proceed like this. She will have to have a general.’, for a second time, Mrs Ratski was prepared for theatre and given a pre-med and muscle relaxant. Removal of the tube and suturing of the trachea and outer muscle and skin only took a few minutes, and then the patient was back in her bed.the evening, when Slavek called, he was relieved to find his mother’s hands free, and all the machines gone. Her throat was bandaged, however, and she still could not speak; this was due to throat ulceration, which is very painful, but ultimately not damaging.a few days she could speak, but we did not know what she was saying. We were able to sit her up in bed, and she could look around at the other patients. Fear and distrust were always in her eyes, and she reacted with dread whenever a doctor came near. We nurses tried to feed her, but she refused; we could not persuade her even to drink.
‘If this goes on, she will have to have another saline drip. She cannot go without fluids,’ Sister said. In the evening when Slavek visited she asked him to try to persuade his mother to drink. But even he could not. He told us that she thought we were trying to poison her, and he could not convince her otherwise. If he brought her drinks and food from outside, she would perhaps take it. So he did, and she drank and ate a little for a few days.the seventh day her sutures and drainage tube were removed, and her condition appeared to be stable. On his ward round, Mr Carter said that if all went well the colostomy could be closed on the tenth post-operative day. He was confident of a complete recovery.the early hours of the ninth day, the night nurse reported extreme restlessness, and signs of pain and distress. The night sister went to the ward and found Mrs Ratski doubled up in pain and moaning piteously. Her pulse was rapid and her temperature high. The abdomen was examined; it had become rigid again. Whilst the night sister was present Mrs Ratski vomited copiously and effortlessly, without retching. Sister was alarmed and called the house surgeon. The time was 5 a.m., and when he arrived only ten minutes later, symptoms of shock were very apparent, and her temperature and pulse had risen again. It all happened very quickly. The patient vomited once more, a green, bile-stained fluid, in a projectile fashion.registrar was called and a quick examination was all that he needed.
‘This is another obstruction. Acute abdominal dilation with fluid and gas could be due to a paralytic ileus. We’ll have to get her to theatre at once. I’ll speak to Carter – and Sister, you alert theatre for an emergency abdominal.’ He turned and spoke to the houseman. ‘Give her a good shot of morphine and get naso-gastric suction going straight away. We will probably need more blood, but have some serum ready until we can get into the blood bank.’registrar was at his best in an emergency – quick, confident, decisive, and, above all, commanding. He performed the operation himself. Part of the intestine was found to be paralysed and dilated with gas, and the area of the original volvulus had adhered to coils of the large intestine and showed signs of gangrene. The sigmoid colon and the rectum were removed, and the rectal orifice closed. The colostomy, which was intended to be temporary, was now permanent.Slavek visited in the evening he found his mother in the same position as she had been nine days before. The only difference was that she did not have a tracheotomy and endotracheal tube. He was deeply distressed. What had happened? He was simply told that his mother had had to go to theatre for further surgery.went right after that. The old lady was in a pitiable state. Two major operations and anaesthetics at her age took their toll. For two weeks she barely clung to life, but we kept her going. The gastric suction was continued for three or four days, and the drip for about a fortnight. Drugs were given by injection, because she would not swallow them. Her abdomen again filled with gas, and a trocar and cannula was thrust into the peritoneal cavity to release the gas. This was done under local anaesthetic and she was too weak to resist. Her mouth, tongue and throat were massively ulcerated long after the naso-gastric tube was removed. The self-retaining catheter had to be changed for cleansing, and she tried to resist, but was too weak to do so effectively. A urinary infection developed, so drugs were given to combat it.she developed a chest infection, so more drugs were ordered – all of which were injected. Her cough reflex was inadequate, so a physiotherapist was called in to stimulate coughing by use of exercises, palpation and postural drainage. Her heart was compromised by her weakened condition, so cardiac stimulants were given. She had been in bed for so long that she developed bedsores, which we treated two-hourly but could not prevent. The abdominal wound, after the second operation, looked as if it was never going to heal and, together with the colostomy, exuded such a foul smell that it was sometimes difficult to go near her.came and went. They tapped her abdomen, listened for abdominal sounds, and conferred over their findings and differing opinions. They took samples of blood for path lab reports on haemoglobin levels and white cell counts; took more blood to measure the electrolyte balance; ordered sputum and urinary analysis; probed orifices; and discussed erythrocyte sedimentation rates.came and went, and, as the weeks passed, they came less and went more quickly. In my experience, consultants, and particularly surgeons, kept an invisible barrier between themselves and their patients. Before and during the operation their professionalism could not be faulted. But once the post-operative stage was reached they became more remote. The house surgeon, the most junior of the doctors, was the only one who spent any time with our patient., in fairness, there was nothing more that they could have done. They had twice, by emergency operation, rescued Mrs Ratski from certain death. After that, it was up to the nursing staff to help maintain life. And this is what we did, day by day, hour by hour.of the most distressing things to witness was her fear of us. Nurses do not usually inspire fear. We asked Slavek if he knew why she was afraid, and he told us that she thought she was in a prison camp where the Nazi doctors carried out forcible experiments on human beings. He tried to reassure her that she was in an English hospital because she had become very ill, and that we were making her better, but it made no difference. She was convinced that we were conducting experiments on her and pointed to her stomach.
‘Look what they have done to me. They have cut me up and pulled my insides out (she pointed to her colostomy). They have interfered with my private parts; it is too terrible to say what they have done. You wouldn’t believe it if I told you. They cut my throat – you saw it. No, my son, this is a medical experiment, the work of the devil. They have no heart, no pity, no soul. They are machines doing the work of the devil.’Ratski was tough, both physically and morally. She had lost almost all her menfolk in wars and insurrections. Political conflict had been her only experience of life, and she had kept going through it all to keep the nucleus of her family alive. During the Second World War she had been in one of the many prison camps, where she must have endured cold, starvation and cruelty. She had been surrounded by death, but somehow survived.hospital, she lived through two operations and began to recover; but with increased strength she became more resistant to our efforts to nurse her. She fought us whenever we came near her, even for benign things like bed making. We tried to give her drugs by mouth, but she hit us and spat at us and knocked them to the floor, so the doctors ordered that drugs be given by injection. This required three nurses – two to hold her down, one to inject. She screamed and shouted what was probably abuse at us, then hit us as soon as she could. She tore off her abdominal dressing, and the colostomy bag; she even managed to pull out the self-retaining catheter. We were at our wits end to know what to do, so paraldehyde was ordered. This was a colourless fluid with a distinctive and revolting smell, which emanated from the patient, and could be smelled for a wide area around. We nurses hated having to inject it, because such a large quantity had to be given with a wide bore needle, thrust deep into the muscle. It certainly sedated the patient, but seemed to have peculiar properties, and I wondered if it was hallucinogenic. When the effect of the drug wore off, after about six hours, patients were often wildly excitable and disorientated.Ratski had been in hospital for five weeks, and during that time I became increasingly troubled. When the paraldehyde started, I could not contain myself any longer. I blurted out to the staff nurse, ‘Why are we giving her this stuff?’
‘Because we have to be able to control her.’
‘But it’s mind-bending! People aren’t the same after they have had it.’
‘I know, but we have to give it.’
‘You are not here to ask questions, Nurse. You had better speak to Sister, if you are worried.’
‘I am worried, and it’s not just the paraldehyde that is worrying me. It’s everything.’took a lot of courage to speak to Sister. The nursing hierarchy in those days was such that a junior student nurse couldn’t speak to a ward sister unless spoken to first, so I asked Staff if she would intercede for me.couple of days later, as I was going off duty, Sister called me back.
‘I understand you are worried about giving paraldehyde to Mrs Ratski, Nurse?’
‘Yes, Sister, and lots of other things, too.’
‘What sort of things?’
‘Everything, I suppose. Her treatment, the operations, the drugs, like cardiac stimulants, antibiotics –just everything…’severe aspect of Sister made me so nervous that I could not continue.
‘You are not criticising the treatment Mrs Ratski has received in this hospital, I trust?’ The words were delivered in such a way that they sounded more like a threat than a question.
‘Oh no, Sister,’ I said hastily, feeling foolish.
‘Good. You may go off duty, Nurse.’few days later, in the middle of a morning’s work, when all hands were needed to cope with the volume of duties we had to finish before lunchtime, Staff came up to me and said, ‘You are to report to Matron’s office at once. I will take over your work here.’those days, the matron of a hospital was a very powerful and influential figure, and most of them were quite outstanding women with remarkable minds, and great character and moral standing. A good matron knew everything that was going on in her hospital, and had her finger on every pulse. She had a prestige and authority that is quite unknown in nursing today. Many a consultant surgeon had been known to quake in his shoes if he received a message requiring him to report to Matron’s office – a junior student nurse might collapse on the spot. Miss W Aldwinkle, OBE was in the top rank.I was not afraid. In fact, I was relieved. I had been called to account for myself once before, in an altercation with a consultant who had pushed me, and I had gained the impression she was a wise and understanding woman. I felt I could talk to her in a way that I could not talk to the ward sister.approached her door and knocked. ‘Please enter,’ a voice called.was a large and beautiful room, in a fine Victorian building that overlooked a spacious courtyard.
‘Sit down, Nurse Lee. I understand that you are worried about the treatment given to Mrs Ratski?’
‘What exactly worries you?’
‘It is hard to put into words. What concerns me is the amount of mental and physical suffering we have put her through. But I think it’s more than that, really.’
‘We always meet suffering in hospitals.’
‘Yes, but this has been inflicted by us.’
‘She would have died if she had not come to hospital.’
‘But what is so wrong with that, Matron? My grandma died a few years ago, and no one thought it was wrong. She had a heart attack and just died. My grandad and my mother were with her. She didn’t have to go through the weeks of suffering Mrs Ratski has endured.’looked steadily at me in a way that encouraged me to continue.
‘Mrs Ratski knew that she was going to die, and she travelled all the way across Europe in order to see her son.’
‘Yes, I know the story.’
‘So why couldn’t she be left to die in peace, like my grandma did?’was only eighteen, and my mind was in turmoil. Vague and disconnected thoughts I barely understood myself came tumbling out.
‘What’s wrong with dying, anyway? We’re all going to die. If we are born, we must die. The road always goes in one direction. There are no alternative routes.’Matron said nothing. I was getting so worked up I had to stand and walk around.
‘You don’t know what that poor old lady has been through, Matron. I do. I have been there day, after day and her suffering has been awful. Simply awful.’
‘I know the extent of her suffering.’
‘And it is all so futile. What has been the purpose?’
‘Mrs Ratski is alive.’
‘But what sort of life is this? We have turned a vigorous, healthy old lady into a pathetic invalid. She will never recover properly. And it may be that her mind has been damaged. She knew what she was doing before she came to us. Now she doesn’t.’
‘Sit down, Nurse.’rang a bell and a maid entered.
‘Would you fetch a pot of tea and two cups, please, and some biscuits?’
‘Yes, Matron.’looked at me and sighed.
‘I can see you are upset, Nurse, and you raise questions I cannot answer. Nobody can. When I was your age, I was a young nurse in the war working in France. Death was all around us. Millions of young men died in that war. Millions. Yet I remember one who came to us with his face blown apart by an explosion. Where his nose, mouth and chin should have been there was just a great, bloody hole. Still, he was alive, and his eyes moved, and his mind obviously worked, though he could not speak because he had no mouth or tongue. The surgeons patched him up; they grafted skin over the shrapnel wound, and he recovered. But he had been a handsome young man, and was now left with two eyes and a ghastly-looking hollow with a hole in it, and a tube in the hole, so that liquid foods could be passed into his stomach.’was now my turn to gaze at her without speaking.
‘I was about eighteen, and like you I thought: “Why have they done this? Surely life with such a face, if you could call it a face, is worse than death.”’did not know what to say. There was a knock at the door and the maid entered with a tray.
‘Thank you, Bertha. Put it here, please.’poured tea.
‘These are deep and terrible subjects, Nurse, to which there can be no answers. I know you are upset, and I understand.’
‘That is a terrible story, Matron. I would not want to live with a face like that. What happened to him?’
‘He lives in an ex-servicemen’s home. He cannot live in the community, because everyone stares and points at him.’
‘So he is still alive! Is he happy?’
‘I do not know. He seems content – he is a gardener, and gardeners are always happy people. And he has a dog. When I was your age I thought as you do. You have just said: “I would not want to live with a face like that.” But I very much doubt if that man would say that he would rather be dead.’
‘But he was young, and he had a whole future in front of him, even with such an affliction. Mrs Ratski is old, she has come to the end of her life. She said she was going to die; she achieved what she wanted to do, and then said she was content to die. The obstruction in her intestines would have meant her suffering would have lasted only a few hours, and she would very likely have died in her son’s arms, like my granny died in my grandad’s arms.’
‘But the medical and nursing professions cannot allow anyone to die, if it can be prevented.’
‘But who are we doing it for? For the benefit of the patient, or the benefit of the medical profession? We say that the welfare of the patient comes first, but I am not so sure. The practice of medical skills and techniques seems to come first.’
‘I am certain that Mrs Ratski has been treated for the best of motives – to preserve life.’
‘But for the rest of her days she will be a decrepit old invalid who will be a burden to everyone!’
‘Human life is precious.’
‘And human death is sacred. Or at least it should be – and would be, if we allowed it to be. In the short experience I have had, sitting with the dying, I can say that the last few hours are always peaceful, almost spiritual. Wouldn’t you call that a sacred time?’
‘Yes, I agree, Nurse, and I have had thirty-five years of nursing experience. I don’t really know what is meant by the term “death agony” because I have never seen it.’ She paused and thought, then added, ‘Perhaps, in a few people, I have seen what can be described as a struggle with death, and it can be distressing to behold. But for the vast majority of people death is gentle, tender.’
‘Well, it’s not like that for Mrs Ratski. The agony has been going on for five or six weeks, and it will continue. She has been deprived of a gentle death.’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.’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.’walked the length of the room and back, then sat down.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.’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.’TO DIEin 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.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.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.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.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.’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.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?’was not so enthusiastic. Washing blankets was not something she had anticipated.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.’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?’, 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.’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.’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.’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.’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.’went upstairs to her bedroom, and threw herself on the bed, and cried as she had never cried before.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.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.’changed tactics.
‘Well, anyway, they can’t talk to her.’
‘But if you let them they would learn some Latvian.’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.day she said: ‘I’m going to ask the nurse to get a screen from supplies.’
‘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.’sighed. ‘You’ll do more harm than good trying to protect them like this.’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.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.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.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.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.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.year was drawing to its close, and the nurse was behind the screens tending Mrs Ratski when a quarrel erupted between the young couple.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.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.’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—’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!’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.’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?’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.’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.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.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.’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…’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.’her disapproval, the district nurse left.did not light a fire. He went to the pub and got blind drunk.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.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.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.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.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.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.’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.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.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.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.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.’s some years sincefelt my servant’s discontent;vigour of his service seemed to pall.noticed this without undue dismayfirst.sometime faltering footwheezing breathjack-knife on the exit from a car —brushed beneath the carpetmy mind —easy-going master.the incidents grew more, patience fled, I turned on him,him with negligence, or worse.said: ‘Your lifetime, now’ve been your faithful slave,to your every need,in clean air for youmade your blood,you from food,what was not required,you to see and hearvaried world;you mobility,your thoughts and passions.now, at last, I’m weary,to rest,to earth and airnourished me,all things must,you go free.say you, master?you grant me my release?’
‘That is not mine to do,’countered;
‘I serve too;serve one whorage at my presumptionI gave you leave to go.is the great Disposer.Him, it’s you who must depart,notice, go,wait for your release.’so it was;servant wentleft me here and everywhere,longer part but whole.
— Philip WorthYEARS AND TENgrandfather’s death has an idealistic quality about it. His span of life had run out, he was cared for by his family, and he died peacefully in his own home. We would all wish to die like that. But, half a century later, we have to face the stark fact that for most of us it is unlikely.so long ago old ag