Orientation questions are a quick and easily administerable tool for assessing a patient’s cognition.
I initially had qualms with this one of the questions is the day of the week – I know for sure that there are some days in which I would answer this question correctly, and it’s made harder for patients as life on the ward is devoid of weekly routines by which one could orient themselves to. The same goes for the date.
Usually people are oriented to the year, the month, the part of the day that they’re in. Sometimes they’re not.
One such man seemed to believe that I was seated in his living room on a January evening in 1997, while we were conversing from his hospital bed in a November morning of 2018. Things like this seem passively strange and even humorous when I read them in notes or see them on tests, but when I’m that situation it takes on an altogether harrowing tone. I know that people’s sense of what and when they are comes from a combination of autobiographial memory, proprioceptive narrative and sensory input. It appears that when the senses or the mechanisms by which we interpret them fail or fade, one is immersed and convinced by memory.
I wondered what I looked like to him – I wondered what my name badge or my clipboard appeared to be. I wonder what the view out of the window next to his bed looked like. I wondered what the curtains I pulled around us in the interests of an illusion of privacy were, and what I was doing with them.
At times I become frustrated with people who are very cognitively impaired – when I have a lot of people to see or things to do, and this person is taking an agonisingly long time to answer questions and complete tasks. But this frustration is swiftly and suddenly quelled by compassion, pity, empathic pain and shame. Who am I to pass judgement or emenate frustration to a person on the last roads of their life, speaking to me and cooperating with me in the only slow and stilted way they are able?
I am sure he could not percieve me as I was (of course I cannot be sure that anyone can perciev anyone as they really ‘are’, nor that what they ‘really are’ is an objective thing – I digress), and I am sure that he did not know what was happening or why I was there. But I am also sure that he was aware of me.
I can’t tell him that I’m sorry, I’m not even sure if I have reason or right to be. But I can be gentle, I can be patient, and I can be soft. I can make a conscious effort to speak softly and smile at him with my eyes, and I can take solace in the knowledge that whoever I was to this man, I was at the very least kind.