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Ronald's Victory

At first I was frustrated with Ronald. After all of the hard work everyone had devoted to his recovery how could he be so foolish, so self-defeating?

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I first met Ronald he was washing dishes at the restaurant of my wife, Nancy.  Hunched over the sink, scrubbing furiously, soap suds flying, he was by far the best dishwasher she employed.

Unfortunately, after 15 minutes this breakneck pace and his asthma would catch up with him and he'd need to take a break. On a bad day he would put down his rag and walk several miles to the emergency room to seek help. Other times he would step out to the parking lot and light up a cigarette.

Frequent absences and inconsistent performance led to Ronald's dismissal. Not once or twice. More like one or two dozen times. Each time he would wait a few days and then return to the restaurant, head bowed, to apologize for letting Nancy down. Nancy had a soft spot for Ronald and was always looking for a good dishwasher. Each time Ronald promised to do better.

Ronald was happy when he was working. Work made him feel useful and provided a few dollars to supplement his small monthly government disability allowance, most of which went to the adult home where he resided. We suspected that work also served as respite from his oppressive living situation.

The details of Ronald's former life are sketchy. He grew up in Richmond, liked sports, did not finish high school, developed serious mental health problems and spent many years at Central State Hospital. When he was discharged, Ronald was ill-prepared for life outside of the asylum. He lived in a series of adult homes that provided minimal care and sustenance. The name itself — adult home — is a cruel euphemism as the residents are frequently treated more like chattel than adults. Usually, the ambiance is as homelike as a bus terminal.

Ronald was considerably more intelligent and aware than most people gave him credit for. Listening to classical music in our car he was able to identify with uncanny accuracy the country from which the music originated. He liked to watch sports on television and offered analysis as good as some of the commentators. When we discussed current events Ronald was as skeptical about our political institutions as we were.

After my wife closed her restaurant Ronald kept in touch. They had coffee each week and he occasionally did yard work at our house. When she picked him up at the adult home, the dismal environment got to her and she asked if he wanted to move to a place of his own. Ronald struggled with this question. He wanted to live on his own but a lifetime of dependence and subordination had eroded his confidence. The idea made him very anxious.

Finally, after several years and false starts Ronald moved into a house with another man, and in some ways he became self-sufficient. He prepared his own meals, cleaned the house and enjoyed exploring the neighborhood.

When asked what he wanted to do with his life, Ronald shrugged. He said he wanted to be with people and work, but preferred to sit at home and watch television. At the same time he complained that he was bored and wanted more for himself.

In the past few years Ronald suffered a series of setbacks. His mother died and he became depressed. He was admitted to a hospital for respiratory problems and spent several months in a deliberately induced coma to help him cope with a serious pulmonary infection.

Ronald left the hospital 60 pounds lighter with a colostomy bag. He regained the weight and his strength and moved back into his own place. He said the colostomy made him feel like a freak, so he had it reversed. Several days after being discharged from the hospital, while eating breakfast in our kitchen, his abdomen burst.

When Ronald arrived at the emergency room he'd lost a lot of blood and his open wound put him at high risk for infection. The doctors were able to stabilize him, and the excellent care he received that day probably saved his life. The doctors determined that the cause of his abdominal evisceration was his poor general health. Years of poor nutrition and a less than healthy lifestyle had left Ronald's body weak. 

Over the course of the next eight months, Ronald endured 18 surgical procedures. His weight plummeted from 140 to fewer than 90 pounds. He was often delirious and when the phone rang at our home we feared that it was someone from the hospital calling to tell us he had succumbed.

But Ronald did not succumb. Surprising even the seasoned staff of the hospital, Ronald struggled back after each surgical procedure, flashing a warm grin when he was alert and maintaining a positive outlook. He always asked how I was doing and if there was anything he could do for me. He listened patiently as I told him how well he was coping with his situation then asked if I could buy him a soda. His wound and the multiple procedures he endured took a toll on his health and stamina but he rarely complained, preferring to talk about the latest Redskins game.

Slowly Ronald regained his stamina and began to recover. When Ronald finally left the hospital he returned to his home. We thought he would be happy to be back in this familiar and comfortable environment but we overestimated his ability to act in his own interest. Although he had not smoked for eight months, in less than a day he lit up a cigarette while still attached to an oxygen tank.

At first I was frustrated with Ronald. After all of the hard work everyone had devoted to his recovery how could he be so foolish, so self-defeating? Before long I realized I was reacting to my own disappointment. Ronald had not told us he was ready to function independently. That had been my aspiration, my expectation.

Ronald moved into a rehabilitation center to receive care for his abdominal wound, which had not completely healed. He seemed happier now that he could eat and move around on his own. Occasionally he watched sports on television. He looked forward to our visits and discussed the presidential campaign. He liked Barack Obama.

He did not show much interest in talking about his future so I was surprised during my visit at the end of January when he announced that he was ready to move on.  He said he wanted to build up his strength so he could leave the rehab center.

A few days later Ronald had difficulty breathing and was admitted to the hospital. I did not see him until he'd lapsed into a coma. The attending physician reported that Ronald had taken off his oxygen and said he was done. This was unusual for Ronald. In the past he had always consented to medical procedures. The doctor conducted a mental exam to determine if he was capable of making this decision. He was. The doctor honored his wish and the nurses tried to make him comfortable.

In early February, hours after he lost consciousness, Ronald died. He was 54. Nancy and I found irony and small consolation in Ronald finally becoming empowered. In those last hours, he was able to decisively express what he wanted for himself.

I have many fond memories of Ronald, tempered by images of him pacing the backyard of the adult home or lying in a hospital bed tethered to life-support machines. Ronald continued to impress me with his intelligence, resilience and genial spirit. In spite of his numerous physical and mental challenges, and the obstacles thrown up by a less-than compassionate community, he managed to maintain a positive outlook.

I can picture Ronald listening to me as I vent my frustration about how our health system once again failed to respond to his needs. He shrugs his shoulders and offers a shy smile that gently chides me for being so naA_ve. S

Bob Cohen is professor of psychiatry at Virginia Commonwealth University.

Opinions expressed on the Back Page are those of the writer and not necessarily those of Style Weekly.

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