A sad day

This weekend I'm on call for the long term care home, aka the nursing home. Many of the people that live there are demented and others for whatever reason, require a level of care that exceeds what can be provided by family members. It's been a busy 2 days. But today, I saw something that in particular gave me a moment of sadness.

I think Alzheimer's is a devastating disease and while those who get it often end up mute & unable to feed themselves at the end of their lives, the earlier stages of the disease can be even more upsetting. I got a new patient this week at the long term care home, a man in his 70's who's Alzheimers-related wandering is more than his poor wife can handle safely. Plus he gets a little aggressive when she repeatedly asks him to do something. Anyway, today was my first time meeting him and I did a physical exam on him. As I was examining his abdomen, I noticed he was wearing 2 pairs of pants - jeans under his slacks. He's quite proud & private and won't have the personal care attendants assist him with dressing. I suggested that he take off the slacks and just wear the one pair of pants. He's very agreeable and all but he has what's called "Apraxia" where he knows what it means to take off his slacks and he can physically move in the required way but he doesn't know how to actually do it, so I needed to show him. Then, when he was down to only 1 pant layer, I noticed that he'd been incontinent of urine and had a large damp stain down his jeans. Unfortunately I couldn't find any clean underwear and he refuses to wear Depends type undergarments (despite this note being the first time he has soiled himself) so I mentioned it to the care person and she went off in search of some clean underwear he could use. He appears to be quite physically healthy and the many women on the floor are swooning over him but I felt quite sad for him. He's at that stage where there's enough awareness to be a little embarrassed about things and yet enough disease to make frequent mistakes/mishaps like not knowing what to do when he gets to the bathroom - I suspect that's what happened causing him to wet himself. It reminded me of my grandma who had Alzheimer's, and repeatedly (I mean REPEATEDLY = 60+ times an hour) asked me where my grandfather was after he'd died and then later, at the stage when she needed to be reminded of where the bathroom was. He also kept looking out the window, patiently & sometimes less patiently, waiting for his brother to come pick him up. I wonder when, or if, he'll realize that this is his new home.