Alert and Oriented (Again and Again)

Hospice ADLs:  My Adventures of Daily Learning.92

Who-are-you800x420_thumbIs the patient alert and oriented?

That was the first official “hospice type” question I learned when I was a hospice chaplain.

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, and very essential questions, to help discern 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 5:30 in the morning (or it’s an early Thursday morning if you’d prefer me to be general). 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 Liam (#4) thunder down the hallway, likely headed toward the back of the house to bother my wife. Continue reading

Leave a Comment

Filed under Hospice

Easy Like A Sunday Morning

I Thessalonians 2:9-13 – The 21st Sunday of Ordinary Time – for Sunday, November 2, 2014

“We preached God’s good news to you, while we worked night and day so we wouldn’t be a burden to you . . .” (I Thessalonians 2:9)

church5Seminary professors taught me that I Thessalonians represented the New Testament’s earliest writing. Paul’s letters to Thessalonica occurred years before the four Gospels were even started. Revelation wasn’t a glimmer in John’s feverish dreams when Paul conveyed his thoughts to the city by the Thermaïkos Gulf. Though Romans is the first of Paul’s New Testament letters, I recall learning (thanks again, long-ago seminary professors) that the murky decisions creating the Christian canon positioned Paul’s writings on length: from longest to shortest. The Greek community read Paul’s sparse notes as much as a decade before the Romans received their wordy epistle.

But I could be wrong. What do I know?

In the years since seminary, I’ve preached and taught and baptized babies and octogenarians and complained about district superintendents and took leaves of absences and married hundreds of men and women and buried hundreds more and attended 2,437 meetings and stumbled into a campus ministry position and started a new church and held hands in countless hospitals and had 5,692 people tell me they appreciated my swell offer to serve on a committee but no-thanks-not-this-year and became a hospice chaplain and sat by rented beds in living rooms as tearful sons bathed dying fathers and weary wives dribbled morphine into their husband’s open, parched lips and led youth through confirmation classes and hiked with kids as young as 7 and adults as old as 70 and all of them—wise and foolish, giddy and afraid—experienced mountains for the first time.

So, while being preoccupied with the minutia of my modest ministry, maybe a passel of professors have discerned that the Book of Hebrews or John’s Gospel was actually written prior to I Thessalonians. Perhaps Romans was first in the batting order of Paul’s letters because it’s been discovered—since I survived seminary—that a drunk monk in 400 CE rearranged a dusty scroll and moved Romans from last to first. Continue reading


Filed under Lectionary - Year A, or Pentecost, Ordinary Time

Ornery Is In Our DNA

Hospice ADLs:  My Adventures of Daily Learning.91

In Joan Halifax’s Being With Dying, she wrote* . . .

World religions scholar Huston Smith once told the story of a well-known psychologist, an ornery old man close to death. One morning, as he was struggling to get to the toilet, a nurse tried to help him. He snapped back at her, “I can do it myself!” Then he dropped to the floor dead.

Smith used this story to illustrate just how defensive about needing help we are often are. He called this reaction ‘the porcupine effect.’

Stubborn starts early. Do humans have an ornery gene in the DNA?

Stubborn starts early. Do humans have an ornery gene in the DNA?

I agree with Smith’s “porcupine effect,” or . . . don’t touch me! Over the years of working with those close to death (and those caring for them) I have frequently heard a variation of the phrase: how you live is how you die. That may not be as true when death happens because of a car accident or an earthquake, but still . . .

During life, some are ornery like Smith’s “well-known psychologist,” and that’s exactly what they are like as they approach death. All humans are many things. Gentle. Crude. Fearful. Talkative. Stoic. Finger-pointers. Self-deprecating. Calm. Anxious. Generous. Miserly. The list of the ways we describe ourselves, or others describe us, is lengthy. But we’re never one thing. We are a stew of emotions, a tossed salad of reactions, a buffet overflowing with contradictions.

But I think most are stubborn. (Or call it ornery.) We are gentle, kind, and stubborn. We are fearful, secretive, and stubborn. We are self-deprecating, touchy-feely, and, yes, stubborn.

  • Don’t help me.
  • I don’t want your assistance.
  • I can do it on my own.
  • Leave me alone.
  • Add your own human warning label: _____________________

Continue reading


Filed under Hospice

Did God Weep?

Deuteronomy 34:1-12 – The 20th Sunday of Ordinary time – for Sunday, October 26, 2014

“Then Moses hiked up from the Moabite plains to Mount Nebo, the peak of the Pisgah slope…” (Deuteronomy 34:1)

Aerial view of Mt. Nebo and surrounding area...

Aerial view of Mt. Nebo and surrounding area…

Did God weep when Moses died? The Book of Deuteronomy never mentioned divine tears.

But I wonder.

Of course, it could be claimed that Deuteronomy only passed along an exaggerated tale, one written by enthusiastic but anonymous scribes, penned to create heroics and a hero, inexplicable miracles and enduring memories. Moses, as unique as he was, and as unique as his relationship with God had been depicted, was still only another human. Somewhere, somehow, Moses died.

In Mary Oliver’s poem The Summer Day, her final lines asked,

Tell me, what is it you plan to do

with your one wild and precious life?

What about when Moses’ “wild and precious life” arrived at its last day? And what about God . . . Continue reading


Filed under Lectionary - Year A, or Pentecost, Ordinary Time

I Don’t Want To Visit Dad

Hospice ADLs:  My Adventures of Daily Learning.90

Before and after the death of a friend or family member, we can feel alone, misunderstood.

Before and after the death of a friend or family member, we can feel alone, misunderstood.

“I don’t want to visit Dad because I want to remember how he was.”

One of our hospice’s social workers relayed this comment from a member of a patient’s family. A child, now an adult, struggled to spend any time with a father. He no longer resembled—or acted like or reacted like—the father of the “past.”

Dying can literally change us. Even if we remain relatively healthy as the birthdays accumulate, there are inevitable and predictable transformations in hair color, skin texture, and a hundred other physical clues. But add a form of dementia, and often there’s no chance for the remember-whens as an adult child tries to support a parent. Add a form of cancer and either the disease, or the treatments for the disease, will wound and warp the body. Add the terminal stages of chronic obstructive pulmonary disease (COPD), and the “normal” act of breathing can appear as frightening as watching a gasping fish out of water.

Anger stirred when I overheard the social worker’s quote from the non-visiting adult child. Continue reading


Filed under Hospice