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Letting Go: Part 1 – Black vomit

Overnight Robert threw up black vomit at 3 am and 5 am. I learned about this when I arrived to visit him today. Elysia said they were just about to call me. Black vomit equals blood. I felt my stomach drop and willed myself to deal with what was in front of me and not jump ahead to a feared, but not yet realized catastrophe.

The meaning of black vomit

Black vomit is made up of dry blood mixed with stomach acid. Fresh blood is red, dried blood is black or brown. Blood in the stomach can come from the esophagus, the stomach itself, or the duodenum (the small intestine). Bleeding in the gastrointestinal (GI) tract can stem from various underlying conditions, but the most common are gastric ulcers or gastritis. These irritations can be caused by bacteria or overuse of NSAIDS like ibuprofen. Robert doesn’t take any NSAIDS, but it is possible that another of his medications is causing GI irritation.

How are you feeling today?

Robert was sitting in the living room in his usual recliner with a fleece draped across his body, his hair stringy and matted to his forehead. The soft, sheer curtains were closed across the bay windows at the front of the house, sending filtered light into the room. Robert was napping. He seemed comfortable with his head lolling gently to one side. He awoke and offered a simple, if mumbled hello. 

I asked him how he was feeling. He said, “Fine, just enjoying my sleep. It’s like a little vacation, and it’s really nice.” 

“Are you warm enough?”

“I’m a little cold right now.”

Robert brightened when Elysia turned up the gas insert under the fireplace mantel. While we sat in companionable silence for an hour, I wondered, where did you go?

Different paths

Our paths have diverged. This is one of the most bizarre aspects of dementia. For 30+ years, Robert and I were tootling along together, enjoying the kids, making plans for the next stage of our lives together, celebrating the financial security we’d worked so hard to achieve, and then BAM!

If I squinted, I could see the slow-moving storm approaching on the horizon. I’d look away, disavow the apparition, excuse Robert’s increasingly odd behavior, deny, deny, deny. But it was not a mirage.

Finding ourselves in this odd place

UFC (Ultimate Fighting Championship) was playing on the TV, petty and mindless compared to what was churning in my head. With a kind of mechanical curiosity, I registered the fighters facing off in the “co-main” event this evening. 

I’m exposed to various odd broadcasts at Robert’s care home, Gardenia Place, and find myself listening and peeking into other worlds that I wouldn’t normally visit. Such is the life of those with dementia. The day proceeds around them with very little input or concern for their desires…largely inexpressible anyway. Robert does like the food shows like Cooking with Bobby Flay with its upbeat, playful hosts. The show reminds him of comedy clubs. He loves the improvisation, the action, the carefully orchestrated chaos. 

How big should my reaction be?

Physicians treat blood in vomit as an acute problem and will advise you to head to the nearest emergency room. More nefarious causes of blood in the vomit are pancreatitis or cancer. These scenarios are too difficult for me to ponder. The emotional commitment is too fraught. The most likely outcome is that today’s black vomit will prove to be one in a long line of physical failings in Robert’s inevitable journey.

What would it change to devote my energy to these failings? My heart breaks with this resignation, but I cannot imagine a better story here.

Robert didn’t look especially pale today (he is not “bleeding out”) and he confirmed that he was not in pain. Moving him or sending him into a new environment like an emergency room would be traumatic and overtaxing. People with dementia do not have the brain energy the rest of us have. The activities we take for granted like eating or talking can be exhausting for a person with dementia. 

Case in point. Robert’s brother, John, calls periodically. Robert is happy to hear from him, but after a moment or two, he puts the phone down, too tired to complete the conversation with a goodbye. 

I made the decision to send a message to Robert’s doctor about the vomit and await further guidance.

Another reminder of where we are

As I readied myself to leave, Fatima, the lead nurse at Gardenia Place, pulled out Robert’s ”Plan of Care” binder to confirm they were acting by our agreed-upon routine. His binder shows his name in big letters center of the cover and a large DNR sticker in the upper right-hand corner. 

The black vomit shattered any illusion that I was just spending time with my husband. Seeing the binder reminded me again that the plateau of familiar behaviors and the particular foibles we’re dealing with today will step down a level in the not-too-distant future. Things will get worse. Things will fall apart. We are managing a progressive illness to Robert’s end. More than anything, I wish I could pull Robert from the brink, bring him back to us.

But I can’t. The only thing to do is to live, love, and laugh in this place and time right now. There is nothing else. I am with Robert wholly when we are together. But I am also slowly, cautiously attempting to remake my life; I’ve been lonely for such a long time. I’ve started dating.

I turned on a cooking show and left Robert to rest.

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