Collateral Damage: Families struggle to care for victims of violence

His mother remembers the way he used to be: a daredevil with an athletic build who drove a red Pontiac Firebird, listened to hard rock bands like Metallica and did handstands on his thumbs.

But when a neighbor waving a gun shot Charles "Chuck" Ropka in the head, the Parkville 18-year-old was left paralyzed on his left side. The shooting derailed the high school graduate's plans to study to become a diesel mechanic. Instead of seeing him move out on his own, his mother, Shirley Ropka, suddenly had to make a place to care for him in the family's basement. And that's where he still lives — 35 years later.

"He gets mad when I say it, but it felt like I had a large baby," said Shirley Ropka, who became his medical aide while caring for three other children. "I was 41, and they always say life begins at 40. My whole life changed. I think more or less I focused on him most of the time."

She and her husband found themselves on a decades-long odyssey — an emotional, physical and financial struggle that illustrates the unseen toll of violence in the Baltimore region. 

Even in Baltimore, which has the fifth-highest murder rate among major U.S. cities, far more people survive violent attacks than die from them. Here, for example, in 2014 there have been 204 homicides and 356 non-fatal shootings. Many of these survivors spend weeks or months in rehabilitation units learning to walk, speak and eat again. Others, like Chuck Ropka, are left with permanent disabilities.

//

For victims who survive a serious brush with violence, a string of relatives often must pick up the pieces. They're loving moms, dads, siblings, aunts and grandmothers who are thankful their relatives survived, but who are unexpectedly thrust into the role of caretaker for someone saddled with severe physical or mental health problems. Long after the adrenaline and terror of the emergency room moments, these families shoulder a heavy burden as new caregivers.

"It can have a tremendous, traumatic impact on people's lives that affects the whole family," said Dr. Michael A. Scharf, a University of Rochester psychiatry professor who has studied the impact of violence on families.

No one knows exactly how many survivors of violence wind up disabled, but some statistics give a glimpse of the numbers: Violence is the third leading cause of spinal cord injuries in the country, affecting about 40,000 people a year. In addition, about 275,000 people suffer traumatic brain injuries caused by violence every year.

Similarly, no one knows exactly how many survivors of violence end up disabled, and in the care of families or as wards of the state.

Strain on the family

In Chuck Ropka's case, the paralysis, which requires him to use a wheelchair, was accompanied by a head injury. Though caring for him was never a question for the Ropkas, who live in a modest, three-story rowhouse, the experience has at times strained the family.

Experts say there is a lack of research on families like the Ropkas, but compare their experience to that of families of injured soldiers back from war. Caregivers who tend to injured soldiers suffer from depression, isolation and financial burdens. They have a higher burden of stress, compared to more typical caregivers, for example, someone who cares for an elderly person, according to a study by the National Alliance for Caregiving. That's because they tend to be in the caregiving role for longer periods of time, and perform more daily tasks such as bathing and feeding a loved one.

"The cost goes into the millions very quickly," said Wanda Page, founder of Disabled Crime Victims Assistance Inc., a Texas nonprofit that works with families like the Ropkas. "The treatment still goes on. It's not like they are paralyzed and that is it."

The Ropkas' younger daughters remember the early years, when paramedics were summoned in the middle of the night because of their brother's frequent seizures. The family wasn't able to go on many outings or vacations. His mother recalls the time she left him to pick up her husband from work, and her son tried to go to the bathroom on his own. He wound up tangled in the toilet, humiliated, and the Fire Department had to be called to help. For years, his mother rarely left him alone again.

That has changed some recently, and his mother tries to block out thoughts about the crime — in which the neighbor was charged but acquitted — and its aftermath. Yet at age 76, she has had plenty of moments when she wondered why this happened to her family. Going to church, Calvary Lutheran, helped.

"I just take each day as it comes along and just deal with it," she said.

Chuck Ropka, 53, is close with his parents and appreciates how they have cared for him over the years. He, too, has learned not to dwell on his past.

"I have to live my life," said Ropka, who communicates well, but sometimes confuses memories because of his brain injury.

Today, the Ropkas must keep up with new health problems that constantly crop up. Two years ago, Chuck Ropka had all his teeth pulled because seizure medicine ate away the enamel. The paralyzed side of his body is stiff because he didn't always go to physical therapy. He lost two toes, fragile from a skin infection, when he banged them on the side of the bed. And because his limbs are so stiff, he once had to ride with his feet hanging out the window of his mother's station wagon.

The family had to reconfigure his basement bedroom with a hospital bed and other changes to fit his new life in a wheelchair. Medicaid, the federal-state health insurance program for the poor and disabled, has covered many of his medical bills. The family has turned to grants and nonprofits for more help.

But Shirley Ropka, who baby-sat children for a living, and her husband, a retired butcher, had to pay for a lot on their own. They took a nearly $15,000 loan — more than the original cost of their house on Red Oak Road — to widen doors and install a wheelchair lift, along with a device to help lift him. Later, Chuck Ropka's stepfather cashed in a $5,500 life insurance policy to pay for an elevator to carry him from the basement to the driveway.

In Maryland, the state program that compensates crime victims paid out nearly half of its claims in 2014 for assaults such as gunshots, stabbings and beatings. (The other half was related to homicide cases.) Much of the money for the assault victims went for health care — $2.7 million for medical and dental claims and $75,000 for mental health claims. About 42 percent of claims were paid to Baltimore residents. But officials with the Criminal Injuries Compensation Board note that the fund is the last resort for victims, who must first tap out private insurance and Medicaid, meaning the overall cost of caring for victims is likely much more. Ropka did not get money from the fund. 

All these families must adjust to a new reality. Neurological damage can alter a person's personality, something families may struggle with, said Melanie Brown, director of Brain Injury Rehabilitation at the LifeBridge Health Brain & Spine Institute, which treats victims of violence who suffer brain injuries.

"It's like the person you knew isn't there anymore," Brown said. "They say things differently. They act differently."

The victims, in turn, also struggle. A small percentage never fully accept their new fate, turn to drugs or alcohol and even end up homeless, advocates say. Younger disabled victims sometimes wind up living in nursing homes, next to people their grandparents' age. 

Brought back home

One Baltimore-area family watched their son deteriorate in a nursing home, so they decided to care for him at home. Shannon Dudley was 22 and attending school to become a barber when he was beaten and stabbed in the heart during a 2008 robbery at a bus stop at Charles and Baltimore streets. He emerged from a coma severely disabled and made some progress at a rehabilitation facility. But once he was sent to a nursing home, he seemed to withdraw. 

So, 14 months after the injury, the family brought him back to the rowhome where he had been living with his mother. He couldn't walk and needed help being fed and bathed. Dudley's maternal grandmother, who was 72 and retired from work as a crossing guard, decided to care for him. 

"It was my grandson," said Nellie Ransome, a petite and determined woman with the strength and energy of someone much younger. "I had to do it." 

Physicians say it's hard to know which patients will recover, and which will suffer lifelong disabilities. With brain damage, the most improvement occurs within the first few months. With physical disabilities, it may take years of physical therapy to make gradual improvements. One factor is the determination of the patient. Dudley at times seems to have given up, but even after six years, his family still believes he will walk again. 

His grandmother arrives each morning at 6 a.m. to get him dressed. She tenderly bathes him, brushes his teeth and slides his stiff body into clothes. His 5-foot-8-inch frame towers above her 5 foot 3 inches, but she manages to lift his body and move him into an old office chair with wheels. She rolls that chair to the top of the steps and slides his body onto a glider chair, which takes him downstairs.

On a recent morning, Ransome held his head and whispered to him, praying with him. She then fed him spoonfuls of eggs, grits and applesauce.

Lately, Dudley now 29, has been feeling pain in his legs. He cries and points to his thin limbs, but can't say what is wrong. His mother and grandmother have spent long nights in the emergency room in hopes that doctors could provide some relief. And his grandmother now tries to exercise his legs each day, wrapping her arms around his chest and lifting him in the air. She then moves each leg back and forth and sways his body from side to side, as if to mimic walking, using her own version of physical therapy.

Two men were convicted in Dudley's assault. His mother, Tilithea Ransome, who commutes to Washington for her work as a pension financial manager for the city, gets angry when she thinks about that day. She believes others were involved. But she tries to focus on giving her son as normal a life as possible.

Most days, Dudley and his grandmother watch television. She steers clear of anything violent, to protect him, and instead, they enjoy reruns of "Martin" and other comedies. Dudley's face lights up and he waves his hands, as his body shakes with laughter at comedian Martin Lawrence's antics.

His mother tries to keep his life as normal as possible and has even managed to take him on trips, including a recent cruise to Mexico. 

Despite the obstacles, Tilithea Ransome 53, is glad her son survived, when so many don't. It is this notion that gives her a positive outlook. 

"My son lived. That was for a reason," she said. "We know he will walk one day. I will never give up hope on him." 

An unclear future

The Ropkas have also leaned on their faith. Stepfather Carl Ropka said their church has helped them cope. They are also fortunate, he said, that services for the disabled — particularly transportation — have improved since his stepson was hurt. An aide comes in several hours a week to take him to the movies and on other outings.

His mother has gone out of her comfort zone to do things for him — even taking him to a strip club once. She rolled his wheelchair to the front entrance, pushed him through the door and then ran off so she didn't have to go in. 

Chuck Ropka, too, has adapted to life in a wheelchair. He goes out on his own several days a week, even wheeling himself to vote on Election Day. He has a "main girl" at The League For People With Disabilities, an adult day care center in Northeast Baltimore that offers rehabilitation services and recreational activities for people with severe physical or neurological disabilities. But he still gets down and frustrated at times.

"Then I just say I'm thankful to be alive," he said. "My life is good to me."

His parents, meanwhile, are getting older. Shirley Ropka needs knee surgery but is postponing it because she needs to take care of her son. For now, she goes up and down the stairs using the chair lift built for him.

And the future is unclear. The Ropkas plan to leave the house to their son, but they don't know who would care for him. Shirley Ropka tries not to think about it that much. She relies on a personal philosophy to get her through each day.

"There's always somebody worse off than you are," she said.

Each night, for all these years, Shirley Ropka goes downstairs and helps her son get ready for bed. In a kind of quiet duet, they work together — he changes his own shirt, and she helps with the pants.

He drags his body onto the bed, and — just as she did when he was growing up — she pulls up the blanket and says good night.

  

This story originally was published by The Baltimore Sun.

Photo Credit: Lloyd Fox/Baltimore Sun