Alert & Oriented, with Dying and Grieving

Alert and oriented might be my earliest hospice memory for describing a patient.

If a patient is alert and oriented, she’ll be able to tell you who she is, her location (“Community Hospital”), the date and time (“It’s Tuesday morning in June of 2018”), and the current president (“President Trump was elected around 2016”). While there could be additional questions, like a birthday or naming children in the patient’s family, those four are relevant and will be revealing about his/her situation.

If someone is confronted with a serious illness, would it really be fair to ask about last year’s Academy Award for best picture? Sure, film geeks may immediately recall The Shape of Water nabbed the 2017 Oscar, but even high-profile entertainment news slips and slides unnoticed into the 24/7 information overload all of us—well or sick—may easily forget.

But if a patient is convinced he’s at his own home when he’s at Autumn Breezes Convalescent Hospital, or that Barack Obama or George Bush or ________ is the one making decisions behind a desk in the Oval Office, our patient may be alert, but he’s certainly not oriented.

Alert. Can you express your needs? Can you appropriately answer questions?

Oriented. Do you know where you are? Who you are? What illness you have?

One of hospice’s key goals is the patient participating in his or her care. When alert and oriented, they can request (for example) levels of medication to help with pain management. Some patients prefer to reduce pain, knowing they may become drowsier and less able to communicate with loved ones. Others, either because of high pain tolerance or the priority of interaction with family and friends, may request lower doses. The more a patient is alert and oriented, the more they can help make decisions and give feedback about their current condition.

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In my work with bereavement, I also wonder about the alert and oriented description for those experiencing a loved one’s death. A common reaction for the surviving partner, child, sibling, friend or parent is . . . “I think I’m going crazy.”

After a death, the grieving person may easily identify the Presidential occupant at 1600 Pennsylvania Avenue, but they’ll forget to eat, abruptly cry, ignore questions, repeat phrases, wander aimlessly, and become stymied by the simplest of tasks.

Some fall apart.

Some appear to be “normal” on the outside, even though a whirlwind endlessly spins within. But the hints happen. Who can stay busy all the time? Tears fall. Laughter dies. Minds wander.

Some, well, with some, you may never know. How clever humans are with hiding emotions. Like the clichéd can, we kick our regrets or hurt or anger down the street. We’ll face them . . . later?

I believe for all, being alert and oriented after a death ebbs and flows.

In my first hospice experiences, I assumed it was only the dying patient who might—or might not—be alert and oriented. Now I suspect it’s a phrase to consider for those who have buried their beloved, and then trudge back into a life that will never be the same again.

In the grief groups I’ve lead, I encourage participants to not be so hard on themselves. You can’t rush grief. The hurt lingers. You can play hide and seek with grief, but it always seems to find your secret place. When grieving, every part of us has bruises; some are literally physical, but the emotional and spiritual wounds are just below the surface.

After a loved one’s death, it might be easy to name the White House’s current temporary resident.

But in our own homes, in our hearts, as we grieve a death and try to rebuild our lives, so much is overwhelming. Don’t be so hard on yourself. (I thought it was important to repeat that . . .)

(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

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  1. I hadn’t really looked at alert and oriented in that light. Thanks for that! And always— the reminder not to be so hard on ourselves.

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