Yesterday was Dad’s 92nd birthday, and we celebrated as we have for the last few years, although this time heartbroken by my deceased brother’s absence.  Mom and I are still trying to cope with that loss every day, though we rarely talk about it beyond a brief mention. His wife stopped by for some cake and ice cream. We all sang Happy Birthday and pretended that Dad blew out the candles–actually he did seem to try. We had told him several times during the day that it was his birthday and we would be having a nice meal and dessert later, but it was hard to know whether the message registered, and it certainly did not stick. He ate the dessert with gusto, as he always does, and enjoyed being the center of attention when we read the birthday cards and gave him a round of hugs.
Later, just before his bedtime, he began fidgeting in his wheelchair, and leaned far forward a couple of times, and declared “I am sick.” Such a clear statement of distress spurs quick action. From his body movements it seemed he might have some pain in his back, but I asked Mom to get a pail for him to vomit in, if it came to that. We decided to get him out of the wheelchair into bed in case his back was hurting, so we went through the nightly drill in about half the usual time with barely more than the usual minor complaints from him. Once he was sitting on the edge of the bed, Mom and I on each side, he asked me,” Why do I hurt?”
If you care for someone with Alzheimer’s you find that one of your biggest frustrations is not being able to determine sources of distress, and when it happens to be acute, the urgency and helplessness together are particularly unsettling. My approach is to continue with his standard routines as much as possible, so I can more easily spot deviations from his norm. This is usually a reasonable and productive strategy, but extreme situations require careful judgment, so apply this suggestion cautiously.
Of course I could not answer his question; I just said, ‘”I don’t know; I will try to find out and help you feel better.”  Now that he was out of his wheelchair, I could reach his lower back. I rubbed it for a while and felt my own relief when he said, “That feels a lot better.” There were no further indications of possible gastric distress, so we got him into bed, always being sure to get him on his side, and he went to sleep quickly with Mom holding his hand, the same as every night now.