The Art of Drowning

I’ve drowned before…

Drowning comes in the form of waves. Eventually, when your ability to fight back has gone, even the smallest wave can make the difference and take you beneath the surface to a place of the unknown.

Many years ago, I faced the inescapable collapse of the software business that we had spent eight years building from nothing. The business climate had nose-dived, and no-one was spending money in the sector that our products served. We went from healthy company to likely extinction in about four months. It seemed that nothing we could do would make a difference.

It was likely we’d end up with nothing. We were going to drown…

Nothing can be a potent idea, and more potent than we know. Facing the idea of nothing – of the removal of our normal world – is a truly sobering process.

The world seems to be drowning at the moment. Hospitals are drowning in the fight against Covid, with doctors and nurses working on seriously ill patients at a level of four or five times their previous maximum load. 

Compared to that, our own troubles should be trivial, but often aren’t.  If you can’t escape them, then they matter –  especially if someone else’s health or even life is in the balance. Not all problems are Covid related.

Two days ago, I was staring at the living pink tube of flesh that protrudes from the lower stomach of a person who survived ulcerative colitis via an operation that removed all of the lower intestines. Such operations require a ‘stoma’ – an aperture stretched into a tube (stomata), through the skin of the abdomen to the outside world from the digestive tract.

The most common forms involve the patient wearing a ‘stoma bag’. The bag replaces the bowel, and often the intestine, and must be emptied, manually, whenever needed. In the case of the ileostomy, which applied in this case, the waste matter is continuously produced by the body without the normal regulation of the intestine and bowel.

The person whose fleshy ‘stoma tube’ I was looking at is a ninety year old woman. She is my mother… Somewhat exhausted, I was wondering why my (untrained) third attempt to attach her stoma bag hadn’t survived for more than two hours.

Two days before that, I had been in an ambulance for the first time in my life, being ferried from Westmorland hospital to the larger Lancaster hospital for my mother to have a CT scan. She had fallen out of bed and landed on her lower back. Resistant to any form of medical treatment at the best of times, she had protested that it was ‘just a bruise’.

The morning after, we knew it was more than that and I drove her into the local Westmorland hospital, where the wonderful Urgent Care Team saw her rapidly, shook their heads and wheeled her off to “give her a rapid MOT”. This led to the rapid diagnosis of a fractured lower back, but, thankfully, not a pelvic injury. The bad news was that it needed a CT Scan at Lancaster Hospital to confirm, which might then lead us on to the specialist team at the Preston Spinal Unit.

An ambulance team were on their way. I was assured that my now-insufficient parking ticket would be overlooked, and mentally watched my car disappear in the distance as the ambulance crew took charge of us – mum now on a stretcher.

She had been staying with us for a few days of care and company to warm her spirits in these difficult and isolating times. Being heavily dependent on us for her health, this was within the brief of the current guidelines. Her vascular dementia has been getting worse, and we hoped that a weekend in Kendal would restore her spirits… and alleviate some of the paranoid fantasies (of theft of money and keepsakes by relatives, for example) that dementia sufferers, living alone, often face.

The ambulance staff were fabulous. They briefed me on how to not be separated to my mother and tagged her so everyone would know I was her official carer and allowed to enter Lancaster A+E alongside her trolley.

There was nothing I could do about it. I made sure we were liberally doused with hand gel and wearing surgical masks. Then I stayed with her, standing by the trolley, within the main A+E corridor.

After two hours, we were told that she could go up to the CT Scanner unit. A porter collected us, and, only fifteen minutes later, we had the results. She had fractured her ‘L3’ vertebra. This had been diagnosed by Westmorland, but needed the more powerful scanner to confirm. Treatment was not possible, but rest and painkillers would assist her body’s own recovery and bone-healing. It could have been much worse…

Fortunately the Preston team, having been sent the scans, confirmed they could add nothing to the diagnosis and the ‘rest and painkillers’ treatment.

My wife, Bernie, came for us at Lancaster…. It was nine in the evening on a day that had begun at ten in the morning.

But now a three day break with us had just become an indefinite period of residence, as there was no chance of her returning to the Bolton terraced house with its steep staircase… possibly ever. Mum has always been fiercely independent and we could imagine what this news would mean to her. But she was uncharacteristically accepting.

We settled her in as best we could. She slept well, exhausted by the events of the day. The following morning I helped her out of bed and she took some painfully slow steps around the bedroom. I helped her to the bathroom and was about to leave when she called out that her stoma bag had burst.

Her ileostomy operation was sixteen years ago. She nearly died from the colitis in the days leading up to it, the surgeon describing her chances as no better than 50:50. The family have been deeply grateful to the surgical team at the Royal Bolton Hospital for those extra years. The stoma is a small price to pay for continued life, and she has managed it on her own, with an occasional visit to the stoma team at Bolton.

But we had not reckoned with the effect of the dementia, combined with the shock of the fall and the spinal fracture. She had literally forgotten how to change her own ‘bag’. Fortunately, we had a box of the stoma supplies at our house for safekeeping. I sat her on the toilet seat and grabbed a pack… I would have to figure it out from the spoiled one now in front of me. I gently peeled it from her sore flesh.

I do not propose to dwell on details. I am the father of two boys and remember the more pungent details of their infant life with nappies. There is a difference between the peachy bottoms of babies and a ninety year old’s stomach, but it’s basically the same science at work.

At that moment, the dawning extent of our new situation was a point of drowning. They are characterised by the knowledge that you can do nothing about the overall nightmare. You just have to put one foot in front of the other and look for any help that might come your way.

Now, three days later, I am able to change a stoma so that it stays sealed, but I’ve made a lot of mistakes. Living in Kendal, Cumbria, we are three counties away from where she is medically registered, but, as she cannot go home, we have at least been able to register her with the local stoma clinic in Lancaster. Some help will be forthcoming, if only to teach me how to do the job properly. We have discussed the situation with her local Bolton doctor of thirty years – who has been very supportive, and advised us that my mother really needs 7×24 care.

It’s that external help that makes all the difference. You know that organised assistance is out there, but can’t access it until someone at the centre of things shows you how.

The experience took me back to the commercial nightmare, now so long ago. Then, three of our largest customers said they did not want us to go bust, and brought forward enough business for us to survive the cash flow crisis. We did; and eventually prospered for another fifteen years until it was time for me to hand over the reins and step away… to do something else, which turned out to be the Silent Eye.

Sometimes we’re not meant to see the logic, or even the pattern. But the rescue from drowning can be there, and not within the scope of our own minds. Small miracles do happen.

So, forgive me for not doing the next instalment of the ‘Big Picture‘ series. By next week, I should be more settled on this new ocean of ongoing uncertainty. I have no intention of drowning.

©Stephen Tanham, 2021.

Stephen Tanham is a Director of the Silent Eye, A journey through the forest of personality to the sunrise of Being.