Alert & Oriented

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 her location (“Community Hospital”), the date and time (“It’s Tuesday morning in June of 2013”) and the current president (“President Obama, elected for a second term in 2012”) While there could be other questions, those three are reasonable and relevant. If someone struggles with an illness, it wouldn’t be fair to ask about last year’s Academy Award for best picture. Sure, film buffs may recall The Artist nabbed the Oscar in 2011, but even high-profile entertainment news slurries into the 24/7 information overload all of us—well or sick—may easily forget or confuse.

obama-reagan1But if a patient is convinced he’s at his own home when he’s lying in a bed at Wishful Thinking Convalescent Hospital or Ronald Reagan is behind a desk in the Oval Room, he 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.

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 death, the grieving person may easily identify who lives at 1600 Pennsylvania Avenue, but they’ll forget to eat, abruptly cry, ignore questions, repeat phrases, wander aimlessly and be flummoxed by simple tasks. Some may go on as if nothing happened. Some fall apart. Some seem “normal” on the outside, though a whirlwind rages inside. Being alert and oriented after a death ebbs and flows.

In my first hospice experiences I assumed it was only the dying person who might—or might not be—alert and oriented. Now I suspect it’s a phrase to consider for those who grieve. During bereavement, it could be easy to name the White House’s current occupant. But in our own home, as we grieve a death and try to rebuild our lives, everything can be overwhelming.

(Like all medical fields, hospice vigorously protects patients’ privacy. I’ll take care with what I share about my experiences. Names will be changed and some events summarized.)

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