4 (Not So) Simple Questions

Is the patient alert and oriented?

That was the first official “hospice type” question I learned when I was a hospice chaplain way back in the late 90s. (Yup, last century!)

Are they alert and oriented times 1, times 2, times 3, or times 4?

Ah, it gets more complicated! Here, as I understand it, are the key questions for determining if a patient is alert and oriented:

  1. Who are you?
  2. Where are you?
  3. What time is it?
  4. What just happened?

These are very basic, universal, and essential health care questions—and not just meaningless jargon—to aid in discerning the current mental status of a patient. Ideally, we all “know” these four answers. I am Larry. I am in Fresno, California. It is about 5:00 in the morning (or it’s an early Tuesday morning if you’d prefer me to be general about when I wrote some of these words). And, finally, not all that much is happening in my (see #1) home (see #2) at this pre-dawn hour (see #3), other than I just heard our kitty Milo slink down the hallway, probably headed toward the back of the house to bother my slumbering wife.

In hospice, #4 is often less a concern. Many hospice patients won’t necessarily know what “just happened” because of medication or temporary disorientation from the recent and unsettling changes in their lives. Even in so-called normal circumstances, we are hard-pressed to recall what has happened earlier today or earlier in the week. What did you have for breakfast this morning? What about your lunch selections three days ago? Details can blur for everyone. Read More →

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The 28 Percent

hospital bed

Of the many hospice statistics that rattle me, 28% is near the top of the list.

According to 2016 statistics, 27.9% of all hospice patients will be served for a week or less. In some cases, much less than a week. Death will come in a couple of days. Or a few hours.

These patients often arrive from a hospital setting, with the family desiring the parent or spouse to die at home. They are frequently cancer patients, and their chemo or radiation treatments were concluded a handful of days before admission. They are old and young. They are male and female. They are alert and comatose.

Many are in pain. Read More →

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When Strangers Meet: Grief Support Groups

grief support group

They will see themselves as strangers. But are they?

Less than a week after posting these words, I will begin another first session of a grief support group for those who have experienced the death of a partner or spouse. I’ve led nearly thirty groups since starting work at a hospice in 2012. (Which truthfully means I’m really not an expert, and probably wouldn’t be even if I’d facilitated twice that many groups.)

There will be men and women. They will be stoic. Uncomfortable. Suspicious. Cautious. A few will cry. A few will fight to hold back tears. Though I don’t ask them to say much in the opening gathering, several will be articulate with their responses. Others might barely manage to mumble their names. Some will remain as still as slabs of granite, while others may be in constant motion (feet tapping, hands gesturing, fiddling with a purse). But I predict everyone will focus on what I say, with several hoping I’ll voice some “magic words” to make them quickly feel better. If so, they will be disappointed. Read More →

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