For the most part, it is standardized and methodical. It is often the odd introduction into a clinical swallow evaluation at the bedside. We learn it in graduate school, practice it during our hospital internships and perfect it throughout our careers. To our lucid patients, we may be embarrassed to ask so we lead with, “Okay, now I am going to ask you a few silly questions.” We expect a certain response but often show grace for minor errors. They are direct objective questions set to elicit specific desired responses. Our eyes may perk when there is a deviation from normal, so we will be sure to document the response and possibly tell a few colleagues about it later during lunch. We seek to achieve some objective information while at the same time establish an odd rapport. Though we are establishing the orientation status of the patient, we may be unintentionally reorienting ourselves.
As Speech-Language Pathologists, we are fortunate to have the bedside opportunity to experience some unique “A/O” responses. A patient may be Alert and Oriented x 1,2,3 or possibly even 4. Often times as I ponder the mental status of a patient, I may get a glimpse into my own “A/O” status. Perhaps, there has been a clinical dry spell and I have been caught-up in the mundane of the basic routine: Cough, Swallow, Nectar, NPO. I need a recharge and special patient interactions often do the trick.
Often times I have left evaluation and treatment sessions thankful for my query into patients’ four-pronged response. I have learned to hear their full response before trying to correct it, sometimes, not correcting them at all.
I have found that it was okay for the time being if the patient wanted to be named “Bob Smith”; I am sure “Bob” was a very nice man with a unique set of experiences.
I’ll still check your wristband, “Bob”, while, you continue to introduce yourself. I am sure Dallas, Texas may be a wonderful place this time of year with clear skies and bright stars; Why not, I’ll pretend to go there with you for a little while. I may help you identify the palm trees outside your window, but Dallas is okay too. Oh, I’ve never been to 1965. Lets talk about it while I transfer you to a chair and secure the bed alarm. Yes, I have heard of The Beatles and No, I can’t imagine what it was like to get your draft notice a month after you got engaged to your college sweetheart, Maggie. This sure looks like a hospital to me, but how nice of you to invite me over to your lovely vacation home, even if it is only for a short while. How about a few small bites and sips from your Dysphagia Puree lunch before you give me the grand tour of your chateau? I know you look forward to getting back home, but it’s a good idea that the Doctors observe you on antibiotics before you leave. We’ll talk, I’ll hopefully fix your pillow to make you more comfortable, we’ll call it therapy and maybe you can teach me more than I can teach you before I have to go.
Person, place, date and situation have blown me away in my clinical experience, but I know I have to stop and make time for it. Sometimes it takes four innocent responses to realize, “This is why I do what I do.” By maintaining silence and going on a brief journey with your “disoriented” patient, one may find ways of recharging the clinical battery and reorienting oneself. I understand that time is critical and establishing such a relationship is definitely not always feasible. However, I urge those who can, to take advantage of those bedside moments to capture the little joys of patient care. Write the memorable responses down, you’ll be glad you did.