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.